Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan.
Dis Colon Rectum. 2010 Feb;53(2):161-8. doi: 10.1007/DCR.0b013e3181b78cb6.
Endoscopic submucosal dissection permits removal of colorectal epithelial neoplasms en bloc, but long-term clinical outcomes remain unknown.
Endoscopic submucosal dissection was performed in 282 patients having 296 colorectal tumors that fulfilled the inclusion criteria, which included lesions greater than 20 mm in size for which en bloc resection would be difficult with endoscopic mucosal resection, lesions with fibrotic scar due to previous endoscopic treatment or biopsies, locally residual lesions after endoscopic resection, or invasive carcinoma with slight submucosal penetration. En bloc or piecemeal resection, complete (en bloc with tumor-free lateral/basal margins) or incomplete resection, and complications were assessed, and factors related to each were analyzed using logistic regression. Patients with early colon cancer received endoscopic follow-up and metastatic surveys for a median of 34 months.
En bloc resection was achieved in 89.2% (264/296) and 234 lesions (79.1%) were deemed to have undergone complete resection. A right-side colonic location was the significant contributor to incomplete resection. Perforation was seen in 24 cases (8.1%) in association with tumor size and the presence of fibrosis. There was 1 case of locally recurrent tumor with incomplete resection, whereas neither recurrence nor residual disease was observed in the complete resection group. Neither cancer-related nor cancer-unrelated death was observed.
Precise assessment of curability with successful en bloc resection may reduce tumor recurrence after endoscopic submucosal dissection. The prognosis of early colorectal cancer in patients treated by endoscopic submucosal dissection is likely to be excellent, although further longer follow-up studies are warranted.
内镜黏膜下剥离术（ESD）可整块切除大肠上皮性肿瘤，但长期临床结果仍未知。
对 282 例符合纳入标准的 296 个大肠肿瘤患者施行 ESD，这些标准包括：内镜黏膜切除术（EMR）难以整块切除的直径＞20mm 的病变；因先前内镜治疗或活检导致纤维化瘢痕的病变；内镜切除后的局部残留病变；或黏膜下浸润轻微的浸润性癌。评估整块或分片切除、完全（肿瘤无侧向/基底边缘残留）或不完全切除及并发症，并采用逻辑回归分析与这些因素相关的因素。早期结肠癌患者接受内镜随访和转移情况调查，中位时间为 34 个月。
整块切除率为 89.2%（264/296），234 个病变（79.1%）被认为完全切除。右半结肠位置是导致不完全切除的重要因素。穿孔与肿瘤大小和纤维化存在有关，共 24 例（8.1%）。1 例不完全切除的局部复发病例，而完全切除组未见复发或残留疾病。无癌症相关或非癌症相关死亡。
通过成功的整块切除进行精确的可治愈性评估可能会降低内镜黏膜下剥离术后肿瘤复发的风险。接受内镜黏膜下剥离术治疗的早期结直肠癌患者的预后可能很好，但需要进一步进行更长时间的随访研究。
