Hotta Kinichi, Fujii Takahiro, Saito Yutaka, Matsuda Takahisa
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Int J Colorectal Dis. 2009 Feb;24(2):225-30. doi: 10.1007/s00384-008-0596-8. Epub 2008 Oct 30.
Local recurrence frequently occurs after endoscopic resection of large colorectal tumors. However, appropriate intervals for surveillance colonoscopy to assess local recurrence after endoscopic resection have not been clarified. The aim of the present study was to determine local recurrence rates following en-bloc and piecemeal endoscopic resection and establish appropriate surveillance colonoscopy intervals based on retrospective analysis of local recurrences.
A total of 461 patients with 572 > or = 10-mm lesions underwent endoscopic resection and follow-up. We retrospectively compared local recurrence rates on lesion size, macroscopic type, and histological type after en-bloc resection (440 lesions) and piecemeal resection (132 lesions). Cumulative local recurrence rates were analyzed using the Kaplan-Meier method.
Local recurrence occurred for 34 lesions (5.9%). Local recurrence rates for the en-bloc and piecemeal groups was 0.7% (3/440) and 23.5% (31/132), respectively (P < 0.001). The difference between the two groups was distinct in terms of lesion size, macroscopic type, and histological type. Of the 34 local recurrences, 32 were treated endoscopically and two cases required additional surgery. The 6-, 12-, and 24-month cumulative local recurrence rate of the en-bloc group was 0.24%, 0.49%, and 0.81%. Then the 6-, 12-, and 24-month cumulative local recurrence rate for the piecemeal group was 18.4%, 23.1%, and 30.7%.
Local recurrence occurred more frequently after piecemeal resection than en-bloc resection. However, almost all cases of local recurrences could be cured by additional endoscopic resection, so piecemeal resection can be acceptable treatment.
大肠大肿瘤内镜切除术后局部复发经常发生。然而，内镜切除术后用于评估局部复发的监测结肠镜检查的合适间隔时间尚未明确。本研究的目的是通过对局部复发的回顾性分析，确定整块和分块内镜切除后的局部复发率，并建立合适的监测结肠镜检查间隔时间。
共有461例患者的572个直径≥10mm的病变接受了内镜切除及随访。我们回顾性比较了整块切除（440个病变）和分块切除（132个病变）后病变大小、宏观类型和组织学类型的局部复发率。采用Kaplan-Meier法分析累积局部复发率。
34个病变（5.9%）发生局部复发。整块切除组和分块切除组的局部复发率分别为0.7%（3/440）和23.5%（31/132）（P<0.001）。两组在病变大小、宏观类型和组织学类型方面差异明显。34例局部复发中，32例接受了内镜治疗，2例需要额外手术。整块切除组6个月、12个月和24个月的累积局部复发率分别为0.24%、0.49%和0.81%。分块切除组6个月、12个月和24个月的累积局部复发率分别为18.4%、23.1%和30.7%。
分块切除后局部复发比整块切除更频繁。然而，几乎所有局部复发病例都可以通过额外的内镜切除治愈，因此分块切除可以是可接受的治疗方法。
