Tang X W, Ren Y T, Zhou J Q, Wei Z J, Chen Z Y, Jiang B, Gong W
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.
Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Dongxiaokou Town, Changping District, Beijing, China.
Tech Coloproctol. 2016 Jul;20(7):437-43. doi: 10.1007/s10151-016-1459-x. Epub 2016 Apr 6.
Endoscopic submucosal dissection (ESD) has been developed to allow en bloc resection of early neoplasia of the gastrointestinal tract, including colorectal tumors. The aim of the present study was to evaluate the safety and efficacy of ESD for laterally spreading tumors (LSTs) in the rectum with diameters of 40 mm or more.
Between January 2010 and October 2014, 35 patients with a total of 36 LSTs of the rectum measuring ≥40 mm were included in this study. Clinical and pathological characteristics and clinical outcomes were examined and analyzed.
The mean operating time was 125.8 ± 61.4 min, and the mean size of the tumors was 59.4 ± 19.8 mm. The rate of en bloc resection and en bloc R0 resection were 91.7 % (33/36) and 88.9 % (32/36), respectively. Perforation occurred in three patients (8.6 %) and was managed conservatively. Postoperative bleeding occurred in one patient (2.9 %) and was treated by endoscopic hemostasis. Excluding five patients, who either underwent additional surgery (n = 1) or were lost to follow-up (n = 4), two patients in our cohort (6.7 %) presented with recurrence of a small adenoma. The remaining patients (n = 28) were free of recurrence during a mean follow-up period of 18.7 ± 4.2 months (range 12-43 months).
Our results indicated that ESD is an effective and safe therapeutic option with high curative rates for LSTs in the rectum ≥40 mm. To prove its long-term efficacy, a large multicenter prospective study is required.
内镜黏膜下剥离术（ESD）已发展用于整块切除胃肠道早期肿瘤，包括结直肠肿瘤。本研究旨在评估ESD治疗直径40mm及以上的直肠侧向发育型肿瘤（LST）的安全性和有效性。
2010年1月至2014年10月，本研究纳入了35例患者，共36个直径≥40mm的直肠LST。对临床和病理特征以及临床结局进行了检查和分析。
平均手术时间为125.8±61.4分钟，肿瘤平均大小为59.4±19.8mm。整块切除率和整块R0切除率分别为91.7%（33/36）和88.9%（32/36）。3例患者（8.6%）发生穿孔，经保守治疗。1例患者（2.9%）发生术后出血，经内镜止血治疗。除5例患者（1例接受了额外手术，4例失访）外，我们队列中的2例患者（6.7%）出现小腺瘤复发。其余患者（n = 28）在平均18.7±4.2个月（范围12 - 43个月）的随访期内无复发。
我们的结果表明，ESD是一种有效且安全的治疗选择，对直径≥40mm的直肠LST具有较高的治愈率。为证明其长期疗效，需要进行大型多中心前瞻性研究。
