Nakajima Kentaro, Sharma Sameer K, Lee Sang W, Milsom Jeffrey W
Section of Colorectal Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 172, New York, NY, 10065, USA.
Surg Endosc. 2016 Mar;30(3):807-18. doi: 10.1007/s00464-015-4279-6. Epub 2015 Jun 20.
A significant proportion of colonic polyps are unsuitable for endoscopic removal. A combined endoscopic and laparoscopic approach is an alternative to conventional polypectomy or resection. In this review, we set out to determine whether avoiding segmental resection for benign colonic polyps was a viable option through combined endolaparoscopic surgery (CELS). We examined the methods and classification criteria different centers employed in their reporting. Finally, we determined whether CELS and procedures methodically similar should be considered as the standard of care today.
A systematic review was performed reporting the outcomes of CELS for benign colorectal polyps. Main outcomes measured included operating time, length of hospital stay and postoperative complications. The CELS data from reports with a larger number of polyps examined were compared to data from representative EMR, ESD and laparoscopic colectomy literature.
Eighteen eligible studies with 532 patients were included. We identified three different CELS techniques: EMR, ESD and full-thickness excision. The operative time for CELS reported in 12 studies varied from 45 to 205 min. The successful endoscopic resection rate ranged from 58 to 100%. Conversion to open surgery was reported in <5%. The length of hospital stay varied from 0 to 7 days. Overall postoperative complications ranged from 0 to 18%. The reports of CELS with more than 20 polyps presented 74-91% successful rate. In comparison with laparoscopic group, CELS groups showed shorter operation time (92-145 vs 125-199 min) and length of hospital stay (1-1.5 vs 4-11 days).
CELS and similar procedures are viable options for intestinal polyps removal. Moving forward, we suggest methods to standardize CELS procedure reporting. The reported outcomes of CELS indicate that it should be seen as a viable alternative to segmental resection when endoscopic methods alone do not suffice.
相当一部分结肠息肉不适合内镜切除。内镜与腹腔镜联合手术是传统息肉切除术或切除术的一种替代方法。在本综述中，我们旨在确定通过内镜腹腔镜联合手术（CELS）避免对良性结肠息肉进行节段性切除是否是一种可行的选择。我们研究了不同中心在报告中采用的方法和分类标准。最后，我们确定如今CELS及方法上类似的手术是否应被视为标准治疗方法。
进行了一项系统综述，报告CELS治疗良性结直肠息肉的结果。主要测量的结果包括手术时间、住院时间和术后并发症。将检查息肉数量较多的报告中的CELS数据与代表性的内镜黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）和腹腔镜结肠切除术文献中的数据进行比较。
纳入了18项符合条件的研究，共532例患者。我们确定了三种不同的CELS技术：EMR、ESD和全层切除术。12项研究报告的CELS手术时间为45至205分钟。内镜切除成功率为58%至100%。转为开放手术的报告率<5%。住院时间为0至7天。总体术后并发症发生率为0至18%。息肉数量超过20个的CELS报告成功率为74%至91%。与腹腔镜组相比，CELS组的手术时间（92 - 145分钟对125 - 199分钟）和住院时间（1 - 1.5天对4 - 11天）更短。
CELS及类似手术是切除肠道息肉的可行选择。展望未来，我们建议规范CELS手术报告的方法。CELS报告的结果表明，当单独的内镜方法不足时，它应被视为节段性切除的可行替代方法。
