Department of Colorectal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
Gastrointest Endosc. 2016 Apr;83(4):800-7. doi: 10.1016/j.gie.2015.08.043. Epub 2015 Sep 1.
Colorectal laterally spreading tumors (LSTs) are divided into homogeneous (LST-G-H), nodular mixed (LST-G-M), flat elevated (LST-NG-F), and pseudodepressed (LST-NG-PD) subtypes. We hypothesized that based on the rates of advanced histology, the recurrence rates of the LST-NG-PD and LST-G-M groups may be higher than those of the other subgroups.
Endoscopic submucosal dissection (ESD) was performed in 156 patients with a total of 177 LSTs. The clinicopathological features and long-term prognosis of ESD according to specific subtype were investigated.
LSTs were most commonly found in the rectum, and the highest percentage of rectal lesions was observed in the LST-G-M group (71.1% vs overall 55.4%, P = .032). The LST-G-M lesions were larger (60 ± 22 mm vs 40 ± 33 mm, P = .034) than the LST-G-H lesions. The LST-G-M group also demonstrated more high-grade intraepithelial neoplasias (32.2% vs 10.8%, P = .003) and submucosal carcinomas (13.6% vs 1.5%, P = .010) compared with the LST-G-H group. The LST-NG-PD group exhibited the highest incidence of submucosally invasive cancer (16.7%). The overall perforation rate was 2.3%. The perforation rate in the LST-NG group was higher than that in the LST-G group (5.7% vs 0.8%, P = .047). All recurrences (7.7%) were found by colonoscopy without any detection of cancers, and no difference was found among the subtypes.
No significant differences were observed among subgroups with 44.4 ± 16.3 months of follow-up. Considering that all recurrences were discovered by colonoscopy and most could be cured by repeated ESD, the LSTs of all subgroups require more intensive follow-up compared with smaller adenomatous lesions.
结直肠侧向发育型肿瘤（LST）分为隆起型（LST-G-H）、结节混合型（LST-G-M）、平坦隆起型（LST-NG-F）和假凹陷型（LST-NG-PD）。我们假设，根据高级组织学的发生率，LST-NG-PD 和 LST-G-M 组的复发率可能高于其他亚组。
对 156 例共 177 例 LST 患者进行内镜黏膜下剥离术（ESD）。根据特定亚型研究 ESD 的临床病理特征和长期预后。
LST 最常见于直肠，LST-G-M 组直肠病变比例最高（71.1%比总体 55.4%，P =.032）。LST-G-M 病变较大（60 ± 22 mm 比 40 ± 33 mm，P =.034）。LST-G-M 组高级上皮内瘤变（32.2%比 10.8%，P =.003）和黏膜下癌（13.6%比 1.5%，P =.010）的比例也高于 LST-G-H 组。LST-NG-PD 组黏膜下浸润癌的发生率最高（16.7%）。总穿孔率为 2.3%。LST-NG 组的穿孔率高于 LST-G 组（5.7%比 0.8%，P =.047）。所有复发（7.7%）均通过结肠镜检查发现，无癌症检出，各亚型间无差异。
在 44.4 ± 16.3 个月的随访中，各亚组之间无显著差异。考虑到所有复发均通过结肠镜检查发现，且大多数可通过重复 ESD 治愈，与较小的腺瘤性病变相比，所有亚组的 LST 都需要更密集的随访。
