Wang Xianfei, Xiang Li, Li Aimin, Han Zelong, Li Yue, Wang Yadong, Guo Yubin, Zuang Kangmin, Yan Qun, Zhong Jietao, Xiong Jing, Yang Haiyun, Liu Side
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Nanfang Hospital, Guangzhou, China.
Int J Colorectal Dis. 2015 Mar;30(3):375-80. doi: 10.1007/s00384-014-2117-2. Epub 2015 Jan 17.
Small rectal carcinoid tumors (<10 mm) are often removed via endoscopic submucosal dissection (ESD). However, the use of ESD for tumors of an intermediate size (7-16 mm) is less well documented. This study aimed to evaluate the efficacy and safety of ESD compared with endoscopic mucosal resection using a cap (EMR-C) for the treatment of 7-16-mm rectal carcinoids.
From September 2007 to August 2012, 55 patients with large rectal carcinoid tumors were treated by EMR-C (30 cases) or ESD (25 cases). The en bloc resection rate, pathological complete response (pCR) rate, procedure time, and incidence rates of complications, local recurrence, and distant metastasis were evaluated.
The basic and clinical characteristics of the patients in the two groups did not differ significantly (p > 0.05). The mean procedure time was longer for ESD than EMR-C (24.79 ± 4.89 vs. 9.52 ± 2.14 min, p < 0.001). The rates of en bloc resection and pCR were higher with ESD than with EMR-C (100 vs. 83.33 %, and 100 vs. 70.00 %, respectively). No patients in the EMR-C group experienced complications. However, in the ESD group, two cases of perforation occurred, and one patient experienced delayed bleeding. These complications were successfully managed via endoscopical therapy. Five cases of local recurrence were detected after EMR-C, whereas no patients experienced recurrence after ESD.
Compared with EMR-C, ESD appears to be a more favorable therapeutic option for the treatment of rectal carcinoid tumors less than 16 mm in diameter based on improved rates of pCR and local recurrence.
小的直肠类癌肿瘤（<10毫米）常通过内镜黏膜下剥离术（ESD）切除。然而，ESD用于中等大小（7 - 16毫米）肿瘤的应用记录较少。本研究旨在评估ESD与使用帽式内镜黏膜切除术（EMR - C）治疗7 - 16毫米直肠类癌的疗效和安全性。
2007年9月至2012年8月，55例直肠大的类癌肿瘤患者接受了EMR - C（30例）或ESD（25例）治疗。评估整块切除率、病理完全缓解（pCR）率、手术时间以及并发症、局部复发和远处转移的发生率。
两组患者的基本和临床特征无显著差异（p > 0.05）。ESD的平均手术时间比EMR - C长（24.79 ± 4.89对9.52 ± 2.14分钟，p < 0.001）。ESD的整块切除率和pCR率高于EMR - C（分别为100%对83.33%，以及分别为100%对70.00%）。EMR - C组无患者发生并发症。然而，ESD组发生了2例穿孔，1例患者出现延迟出血。这些并发症通过内镜治疗成功处理。EMR - C后检测到5例局部复发，而ESD后无患者复发。
与EMR - C相比，基于提高的pCR率和局部复发率，ESD似乎是治疗直径小于16毫米的直肠类癌肿瘤更有利的治疗选择。
