Department of General Surgery and Digestive Cancerology, Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet 2, 151 Route de Saint Antoine de Ginestière, BP 3079, Nice Cedex 3, France.
Int J Colorectal Dis. 2012 Nov;27(11):1473-8. doi: 10.1007/s00384-012-1464-0. Epub 2012 Mar 29.
The treatment of early-stage colorectal cancers removed endoscopically depends on histopathologic findings. This study aimed to assess the benefit-risk balance for patients who underwent additional surgery after endoscopic resection of a T1 carcinoma with unfavorable histology.
From 2000 to 2010, 64 consecutive patients were included in this retrospective study. Specimens resected after endoscopic polypectomy showed at least one of the following unfavorable factors: no free margin, lymphovascular invasion, poorly differentiated grade, SM2-3 involvement (submucosal invasion greater than 300 μm from the muscularis mucosae), tumor budding, sessile morphology, and piecemeal resection. The main objective was to assess the benefit-risk balance of an oncological resection performed after the polypectomy. Oncological benefit was measured by the lymph node metastasis rate and the persistence of a residual adenocarcinoma on the specimen. The risk was measured by the occurrence of severe complications of grade III-IV or death. The associations between these end points and clinicopathologic variables were evaluated by univariate analysis and logistic regression.
Five patients (7.8 %) had lymph node metastases and two (3.1 %) had residual carcinomas. Eight patients (12.5 %) had grade III-IV morbidity. There were no deaths. Oncological benefit was associated by logistic regression analysis with patients who presented multiple criteria (≥2) that led to surgery (p = 0.031). The benefit-risk balance was favorable only for those patients.
Additional surgery is required for patients who present multiple adverse histological criteria. If only one criterion is selected, the indication should be discussed, especially for patients with multiple comorbidities.
经内镜切除的早期结直肠癌的治疗取决于组织病理学发现。本研究旨在评估内镜切除 T1 癌伴不利组织学特征后行额外手术的患者的获益-风险平衡。
本回顾性研究纳入了 2000 年至 2010 年期间的 64 例连续患者。内镜息肉切除术后切除的标本至少存在以下一种不利因素：无自由边缘、脉管侵犯、低分化程度、SM2-3 受累（黏膜下层侵犯超过从黏膜肌层到肌层 300μm）、肿瘤芽生、无蒂形态和分片切除。主要目的是评估息肉切除后进行的肿瘤切除术的获益-风险平衡。肿瘤获益通过淋巴结转移率和标本上残留的腺癌来衡量。风险通过 III-IV 级严重并发症或死亡的发生来衡量。通过单因素分析和逻辑回归评估这些终点与临床病理变量之间的关联。
5 例患者（7.8%）发生淋巴结转移，2 例患者（3.1%）有残留癌。8 例患者（12.5%）发生 III-IV 级并发症。无死亡病例。逻辑回归分析显示，多个标准（≥2）导致手术的患者，肿瘤获益与分析结果相关（p=0.031）。仅当患者存在多个不利组织学标准时，才需要进行额外手术。如果只选择一个标准，则应讨论适应证，尤其是对于合并多种合并症的患者。
对于存在多个不利组织学标准的患者，需要进行额外手术。如果只选择一个标准，则应讨论适应证，尤其是对于合并多种合并症的患者。
