Abdelaziz Mohamad, Sayed Motaz
Department of Tropical Medicine and Gastroenterology, University of Sohag, Egypt ; Mohamad Dossary Hospital, Saudi Arabia.
Mohamad Dossary Hospital, Saudi Arabia ; Department of Internal Medicine, University of Ein Shams, Egypt.
Middle East J Dig Dis. 2017 Jan;9(1):49-54. doi: 10.15171/mejdd.2016.51.
Laterally spreading tumors (LSTs) are generally defined as superficial lesions ≥10 mm in diameter that typically extend laterally rather than vertically along the colonic wall. Such lesions are now increasingly reported because of increased awareness and the introduction of chromo and magnifying colonoscopy. Although the clinicopathological characteristics and the efficacy of endoscopic management of LSTs have been defined in Japanese cohorts, reports from the Middle East are lacking where surgical resection is the mainstay of treatment. We report a case with an LST about 20 cm from anal verge removed by endoscopic mucosal resection. After histopathological evaluation of the removed specimen, we categorized the patient as having high risk early colon cancer. The intensive follow-up as an additional treatment strategy was chosen for the patient. This review addresses the management of early carcinoma in colorectal polyp with reference to proper preoperative assessment, treatment selection with special attention to role of biomarkers, the need for additional treatment on the basis of the presence of risk factors and endoscopic follow-up after treatment.
侧向发育型肿瘤（LSTs）通常被定义为直径≥10 mm的浅表性病变，其通常沿结肠壁侧向而非垂直方向扩展。由于人们的认识提高以及色素和放大结肠镜检查的引入，此类病变现在的报道越来越多。尽管在日本队列中已明确了LSTs的临床病理特征和内镜治疗效果，但中东地区缺乏相关报道，该地区以外科手术切除为主要治疗手段。我们报告了1例距肛缘约20 cm的LST经内镜黏膜切除术切除的病例。对切除标本进行组织病理学评估后，我们将该患者归类为高危早期结肠癌。为该患者选择了强化随访作为额外的治疗策略。本综述参考适当的术前评估、特别关注生物标志物作用的治疗选择、基于危险因素的存在进行额外治疗的必要性以及治疗后的内镜随访，探讨了结直肠息肉早期癌的管理。
