Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai 200032, China.
Int J Colorectal Dis. 2013 Jan;28(1):63-72. doi: 10.1007/s00384-012-1543-2. Epub 2012 Jul 29.
This study aims to investigate the clinicopathological features of specific subtypes of laterally spreading tumor (LST) and assessed the outcome of endoscopic submucosal dissection (ESD) based upon subdifferentiation status.
A total of 137 LSTs were present in 135 patients; 96 were granular and 41 exhibited a nongranular pattern. Granular LSTs, subdivided into homogeneous and nodular mixed, and nongranular LSTs, subdivided into flat-elevated and pseudodepressed, were retrospectively evaluated with respect to clinicopathological features and results of ESD (en bloc R0 curative resection, procedure time, complication, and recurrence rate) according to specific subtype.
The distribution of high-grade intraepithelial neoplasia and submucosal carcinomas was more prominent among granular nodular mixed tumors than among granular homogeneous tumors (P = 0.007), whereas there was no significant difference between nongranular pseudodepressed tumors and flat-elevated tumors. The frequency of en bloc R0 curative resection did not differ significantly among specific subtypes. For nodular mixed and pseudodepressed lesions, the median tumor size was significantly larger (P < 0.001 for each) and mean procedure time was also longer (P < 0.05 for each) than for the other two subtypes. All complications, which included three perforations, five episodes of postoperative bleeding, and one recurrence, occurred in granular nodular mixed and nongranular pseudodepressed tumors.
The risk of cancer varies with the subtypes of LSTs. ESD is an effective treatment for LSTs, however ESD is more technically demanding and carries more complications in pseudodepressed and granular mixed subtypes.
本研究旨在探讨侧向伸展型肿瘤（LST）特定亚型的临床病理特征，并根据亚分化状态评估内镜黏膜下剥离术（ESD）的治疗效果。
共纳入 135 例患者的 137 个 LST 病灶，其中 96 个呈颗粒状，41 个呈非颗粒状。回顾性分析颗粒状 LST（分为均质型和结节混合型）和非颗粒状 LST（分为扁平隆起型和假凹陷型）的临床病理特征和 ESD 治疗结果（整块 R0 治愈性切除、手术时间、并发症和复发率），并根据具体亚型进行评估。
与颗粒状均质型肿瘤相比，颗粒状结节混合型肿瘤中高级别上皮内瘤变和黏膜下癌的分布更为明显（P = 0.007），而假凹陷型和扁平隆起型肿瘤之间则无显著差异。不同亚型的整块 R0 治愈性切除率无显著差异。结节混合型和假凹陷型肿瘤的中位肿瘤直径显著大于（P < 0.001），平均手术时间也较长（P < 0.05）。所有并发症（包括 3 例穿孔、5 例术后出血和 1 例复发）均发生在颗粒状结节混合型和非颗粒状假凹陷型肿瘤中。
LST 亚型的癌变风险不同。ESD 是治疗 LST 的有效方法，但在假凹陷型和颗粒状混合型肿瘤中，ESD 技术要求更高，并发症更多。
