Gangireddy Venu Gopala Reddy, Coleman Teresa, Kanneganti Praveen, Talla Swathi, Annapureddy Amarnath Reddy, Amin Rajan, Parikh Samip
United Hospital Center, 527 Medical Park Drive, Suite 402, Bridgeport, WV, 26330, USA.
John D. Archbold Memorial Hospital, Thomasville, GA, 30901, USA.
Int J Colorectal Dis. 2018 Oct;33(10):1349-1357. doi: 10.1007/s00384-018-3101-z. Epub 2018 Jun 24.
The colon cancer survival rate is significantly affected by location, stage, and size of the cancer. Polypectomy was shown be as equally effective as surgery in early-stage colon cancer, but there have been no established clinical guidelines in the management of colon cancer based on the size of the polyp or the tumor location. The aim of our study was to assess the early-stage colon cancer-specific survival rate in patients who underwent endoscopic polypectomy versus surgery, based on size and location of tumor in early-stage colon cancer.
This is a population-based nationwide study in the USA.
Of 13,157 patients, 15.5% underwent endoscopic treatment and 84.5% underwent surgical therapy. For early cancer tumors located in the left colon, polypectomy yielded comparable 5-year survivals to surgery irrespective of size of the tumors. Five-year early cancer-specific survivals were similar for tumors located in the right colon that were < 20 mm in size (94.5 vs 94.3%, p value = 0.94). However, tumors > 20 mm in size that were located in the right colon had better survivals when treated surgically compared to those treated with polypectomy (20-39 mm: 91.8 vs 74.2%; ≥ 40 mm: 92.4 vs 60%, both p values < 0.01). Similar results were obtained on propensity score analysis.
Polypectomy was as effective as surgical therapy for small tumors. For larger tumors, surgical therapy is better than polypectomy for right-sided tumors, but both are equally effective for left-sided tumors.
结肠癌的生存率受癌症位置、分期和大小的显著影响。在早期结肠癌中，息肉切除术已被证明与手术同样有效，但基于息肉大小或肿瘤位置的结肠癌管理方面尚无既定的临床指南。我们研究的目的是根据早期结肠癌肿瘤的大小和位置，评估接受内镜息肉切除术与手术治疗的患者的早期结肠癌特异性生存率。
这是一项基于美国全国人口的研究。
在13157例患者中，15.5%接受了内镜治疗，84.5%接受了手术治疗。对于位于左半结肠的早期癌性肿瘤，无论肿瘤大小如何，息肉切除术产生的5年生存率与手术相当。对于位于右半结肠且大小<20 mm的肿瘤，5年早期癌特异性生存率相似（94.5%对94.3%，p值 = 0.94）。然而，位于右半结肠且大小>20 mm的肿瘤，手术治疗后的生存率优于息肉切除术（20 - 39 mm：91.8%对74.2%；≥40 mm：92.4%对60%，两个p值均<0.01）。倾向评分分析也得到了类似结果。
对于小肿瘤，息肉切除术与手术治疗同样有效。对于较大肿瘤，手术治疗对右侧肿瘤优于息肉切除术，但对左侧肿瘤两者同样有效。
