Kaneko Hiroaki, Hirasawa Kingo, Koh Ryonho, Kobayashi Ryousuke, Kokawa Atsushi, Tanaka Katsuaki, Maeda Shin
a Department of Gastroenterology , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
b Division of Endoscopy , Yokohama City University Medical Center , Yokohama , Japan.
Scand J Gastroenterol. 2016 Dec;51(12):1489-1494. doi: 10.1080/00365521.2016.1216591. Epub 2016 Aug 9.
In Japan, most of colorectal carcinoid tumors developed in rectum. The choice of treatment is important because surgical treatment may need to construct artificial anus. Although curative endoscopic resection (ER) is desirable from the point of quality of life, sufficient evidence of endoscopic treatment for rectal carcinoid tumors is not fully obtained.
Between April 2001 and August 2013, 46 rectal carcinoid tumors in 46 patients who underwent either with endoscopic mucosal resection with a ligation device (EMR-L) or endoscopic submucosal dissection (ESD) were analyzed retrospectively. The rates of en bloc resection, positive for lateral and/or vertical margin, curative resection, local recurrence, additional treatments, overall and disease-specific survival rate after ER were evaluated during follow-up (median observation period 61.6 months).
Twenty-two lesions were treated by EMR-L and 24 lesions were treated by ESD. Both groups had similar mean tumor size (EMR-L: 6.2 mm, ESD: 6.0 mm). The rate of en bloc resection, negative for both lateral and vertical margins, and curative resection were, respectively, 73%, 63%, and 50% for EMR-L, 100%, 100%, and 83% for ESD. These results suggested that the rate of resectability and curability for ESD was significantly higher than EMR-L (p < 0.05). Complications such as perforation and bleeding did not occur in both groups. Fifteen patients were judged as non-curative and 3 patients underwent additional surgery and lymph node metastasis was evident in 1 patient. Remained 11 patients were carefully followed-up, and so far no obvious recurrence was found. Thirty-two patients (84%) were eligible for long-term follow-up and 5-year overall and disease-specific survival rates were 100% and 100%, respectively.
The long-term outcomes of ER for rectal carcinoid tumors were excellent. ESD has advantage for resectability and curability compared with EMR-L; therefore, ESD is more favorable procedure as treatment for rectal carcinoid tumors.
在日本，大多数结直肠类癌发生于直肠。治疗方法的选择很重要，因为手术治疗可能需要造人工肛门。尽管从生活质量角度来看，根治性内镜切除（ER）是理想的，但对于直肠类癌的内镜治疗，尚未充分获得足够的证据。
回顾性分析2001年4月至2013年8月期间46例接受使用结扎装置的内镜黏膜切除术（EMR-L）或内镜黏膜下剥离术（ESD）的患者的46个直肠类癌肿瘤。在随访期间（中位观察期61.6个月）评估整块切除率、侧切缘和/或垂直切缘阳性率、根治性切除率、局部复发率、额外治疗情况、ER后的总生存率和疾病特异性生存率。
22个病变采用EMR-L治疗，24个病变采用ESD治疗。两组的平均肿瘤大小相似（EMR-L：6.2毫米，ESD：6.0毫米）。EMR-L的整块切除率、侧切缘和垂直切缘均为阴性率以及根治性切除率分别为73%、63%和50%，ESD分别为100%、100%和83%。这些结果表明ESD的可切除性和根治性率显著高于EMR-L（p<0.05）。两组均未发生穿孔和出血等并发症。15例患者被判定为非根治性，3例患者接受了额外手术，1例患者有明显的淋巴结转移。其余11例患者进行了密切随访，迄今为止未发现明显复发。32例患者（84%）符合长期随访条件，5年总生存率和疾病特异性生存率分别为100%和100%。
直肠类癌肿瘤ER的长期结果良好。与EMR-L相比，ESD在可切除性和根治性方面具有优势；因此，ESD作为直肠类癌肿瘤的治疗方法更有利。
