Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
University of Sydney, Sydney, Australia.
Gut Liver. 2017 Nov 15;11(6):747-760. doi: 10.5009/gnl16523.
Serrated polyps are important contributors to the burden of colorectal cancers (CRC). These lesions were once considered to have no malignant potential, but currently up to 30% of all CRC are recognized to arise from the serrated neoplasia pathway. The primary premalignant lesions are sessile serrated adenomas/polyps (SSA/Ps), although traditional serrated adenomas are relatively uncommon. Compared to conventional adenomas, SSA/Ps are morphologically subtle with indistinct borders, may be difficult to detect endoscopically, are more prevalent than previously thought, are associated with synchronous and metachronous advanced neoplasia, and have a higher risk of incomplete resection. Although many lesions remain "dormant," progressive disease is associated with the development of dysplasia and more rapid progression to CRC. As a result, SSA/Ps are strongly implicated in the development of interval cancers. These factors represent unique challenges that require a meticulous approach to their management. In this review, we summarize the contemporary literature on the characterization, detection and resection of SSA/Ps.
锯齿状息肉是结直肠癌（CRC）负担的重要贡献者。这些病变曾经被认为没有恶性潜能，但目前高达 30%的 CRC 被认为是起源于锯齿状肿瘤发生途径。主要的前恶性病变是无蒂锯齿状腺瘤/息肉（SSA/Ps），尽管传统的锯齿状腺瘤相对少见。与传统腺瘤相比，SSA/Ps 在形态上较为微妙，边界不明显，可能难以在内镜下检测到，其流行程度比以前认为的要高，与同时性和异时性高级别肿瘤相关，并且有更高的不完全切除风险。尽管许多病变仍处于“休眠”状态，但进行性疾病与发育不良的发展以及更快速地进展为 CRC 相关。因此，SSA/Ps 强烈提示间隔期癌症的发生。这些因素代表了独特的挑战，需要对其进行细致的管理。在这篇综述中，我们总结了关于 SSA/Ps 的特征、检测和切除的当代文献。
