Nayor Jennifer, Rotman Stephen R, Chan Walter W, Goldberg Joel E, Saltzman John R
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02446, USA.
Harvard Medical School, Boston, MA, USA.
Dig Dis Sci. 2017 Aug;62(8):2120-2125. doi: 10.1007/s10620-017-4591-1. Epub 2017 May 2.
Colonoscopic location of a tumor can influence both the surgical procedure choice and overall treatment strategy.
To determine the accuracy of colonoscopy in determining the location of colon cancer compared to surgical localization and to elucidate factors that predict discordant colon cancer localization.
We conducted a retrospective cross-sectional study of colon cancers diagnosed on colonoscopy at two academic tertiary-care hospitals and two affiliated community hospitals from 2012 to 2014. Colon cancer location was obtained from the endoscopic and surgical pathology reports and characterized by colon segment. We collected data on patient demographics, tumor characteristics, endoscopic procedure characteristics, surgery planned, and surgery performed. Univariate analyses using Chi-squared test and multivariate analysis using forward stepwise logistic regression were performed to determine factors that predict discordant colon cancer localization.
There were 110 colon cancer cases identified during the study period. Inaccurate endoscopic colon cancer localization was found in 29% (32/110) of cases. These included 14 cases (12.7%) that were discordant by more than one colonic segment and three cases where the presurgical planned procedure was significantly changed at the time of surgery. On univariate analyses, right-sided colon lesions were associated with increased inaccuracy (43.8 vs 24.4%, p = 0.04). On multivariate analysis, right-sided colon lesions remained independently associated with inaccuracy (OR 1.74, 95% CI 1.03-2.93, p = 0.04).
Colon cancer location as determined by colonoscopy is often inaccurate, which can result in intraoperative changes to surgical management, particularly in the right colon.
肿瘤在结肠镜检查中的位置可影响手术方式的选择及整体治疗策略。
与手术定位相比，确定结肠镜检查在判定结肠癌位置方面的准确性，并阐明预测结肠癌定位不一致的因素。
我们对2012年至2014年在两家学术性三级护理医院及两家附属社区医院通过结肠镜检查诊断出的结肠癌进行了一项回顾性横断面研究。结肠癌位置取自内镜及手术病理报告，并按结肠段进行特征描述。我们收集了患者人口统计学资料、肿瘤特征、内镜检查程序特征、计划手术及实施手术等数据。采用卡方检验进行单因素分析，采用向前逐步逻辑回归进行多因素分析，以确定预测结肠癌定位不一致的因素。
研究期间共确定110例结肠癌病例。29%（32/110）的病例存在内镜下结肠癌定位不准确的情况。其中包括14例（12.7%）定位相差超过一个结肠段的病例，以及3例术前计划手术在手术时发生显著改变的病例。单因素分析显示，右侧结肠病变与定位不准确的增加相关（43.8%对24.4%，p = 0.04）。多因素分析显示，右侧结肠病变仍与定位不准确独立相关（比值比1.74，95%可信区间1.03 - 2.93，p = 0.04）。
结肠镜检查所确定的结肠癌位置常常不准确，这可能导致手术管理在术中发生改变，尤其是在右半结肠。
