Department of Gastroenterology, Hôpital Nord, Chemin des Bourrely, 13915 Marseille cedex 20, France.
World J Gastroenterol. 2010 Feb 7;16(5):588-95. doi: 10.3748/wjg.v16.i5.588.
To evaluate the feasibility and the outcome of endoscopic mucosal resection (EMR) for large colorectal tumors exceeding 4 cm (LCRT) undergoing piecemeal resection.
From January 2005 to April 2008, 146 digestive tumors larger than 2 cm were removed with the EMR technique in our department. Of these, 34 tumors were larger than 4 cm and piecemeal resection was carried out on 26 colorectal tumors. The mean age of the patients was 71 years. The mean follow-up duration was 12 mo.
LCRTs were located in the rectum, left colon, transverse colon and right colon in 58%, 15%, 4% and 23% of cases, respectively. All were sessile tumors larger than 4 cm with a mean size of 4.9 cm (4-10 cm). According to the Paris classification, 34% of the tumors were type Is, 58% type IIa, 4% type IIb and 4% type IIc. Pathological examination showed tubulous adenoma in 31%, tubulo-villous adenoma in 27%, villous adenoma in 42%, high-grade dysplasia in 38%, in situ carcinoma in 19% of the cases and mucosal carcinoma (m2) in 8% of the cases. The two cases (7.7%) of procedural bleeding that occurred were managed endoscopically and one small perforation was treated with clips. During follow-up, recurrence of the tumor occurred in three patients (12%), three of whom received endoscopic treatment.
EMR for tumors larger than 4 cm is a safe and effective procedure that could compete with endoscopic submucosal dissection, despite providing incomplete histological assessment.
评估内镜黏膜切除术（EMR）治疗超过 4cm 的大肠肿瘤（LCRT）的可行性和疗效，这些肿瘤需要进行分片切除。
自 2005 年 1 月至 2008 年 4 月，我科采用 EMR 技术切除了 146 例直径大于 2cm 的消化道肿瘤，其中 34 例肿瘤直径大于 4cm，26 例大肠肿瘤行分片切除术。患者年龄平均为 71 岁，平均随访时间为 12 个月。
LCRT 位于直肠、左半结肠、横结肠和右半结肠，分别占 58%、15%、4%和 23%。均为直径大于 4cm 的无蒂息肉样肿瘤，平均直径为 4.9cm（4-10cm）。根据巴黎分类，34%的肿瘤为 I 型，58%为 IIa 型，4%为 IIb 型，4%为 IIc 型。病理检查显示管状腺瘤 31%，管状绒毛状腺瘤 27%，绒毛状腺瘤 42%，高级别上皮内瘤变 38%，原位癌 19%，黏膜内癌（m2）8%。发生 2 例（7.7%）术中出血，均行内镜治疗，1 例小穿孔用夹闭器治疗。随访期间，3 例（12%）患者肿瘤复发，其中 3 例接受内镜治疗。
EMR 治疗直径大于 4cm 的肿瘤是一种安全有效的方法，可以与内镜黏膜下剥离术相媲美，尽管其提供的组织学评估不完全。
