Tan W J, Ng N Zp, Chen Y D, Chee Y H M, Foo F J, Tang C L, Chew M H
Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia Level 5, Singapore, 169856, Singapore.
Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore.
BMC Gastroenterol. 2018 Aug 29;18(1):133. doi: 10.1186/s12876-018-0861-4.
Synchronous polypectomy in colonic malignancies is contentious due to the perceived risks of tumour implantation at polypectomy sites (PS). We assess the risks of tumour implantation after synchronous polypectomy.
An analysis of all endoscopies for cancer that were accompanied by synchronous polypectomies from 2005 to 2009 was performed. The incidence of metachronous colorectal cancers located at the same segment of a previous PS was the surrogate for tumour implantation. Data on patient demographics, tumour and polyp location(s) and follow-up outcomes were extracted. The rate of metachronous lesions at the same segment of a previous PS between patients who had all synchronous PS resected (Group A) and patients with PS left in-situ (Group B) were compared.
Two hundred and eighty-four patients had synchronous polypectomy performed during their initial endoscopy for cancer. Three patients were lost to follow-up and, in the remaining 281 patients, 87 (31.0%) were in Group A while 194 (69%) were in Group B. Median age, gender, tumour location, tumour stage, and pathological characteristics were similar between both groups. 2 (0.7%) patients developed local recurrences. Six (2.1%) patients developed metachronous lesions, four of which were located at the same segment where synchronous polypectomy was previously performed. The rates of metachronous lesions at the PS in groups A and B were similar at 1.1% (1/87) and 1.5% (3/194), respectively (p = 0.795).
Malignant implantation after synchronous polypectomy in the setting of a newly diagnosed cancer remains unproven. Even if tumor implantation did occur, the incidence is likely low.
由于担心在结肠恶性肿瘤同步息肉切除术中息肉切除部位（PS）发生肿瘤种植，因此存在争议。我们评估同步息肉切除术后肿瘤种植的风险。
对2005年至2009年所有伴有同步息肉切除术的癌症内镜检查进行分析。位于先前息肉切除部位同一段的异时性结直肠癌的发生率作为肿瘤种植的替代指标。提取患者人口统计学、肿瘤和息肉位置以及随访结果的数据。比较所有同步息肉切除部位均被切除的患者（A组）和息肉保留原位的患者（B组）在先前息肉切除部位同一段的异时性病变发生率。
284例患者在初次癌症内镜检查时进行了同步息肉切除术。3例患者失访，在其余281例患者中，87例（31.0%）在A组，194例（69%）在B组。两组之间的年龄中位数、性别、肿瘤位置、肿瘤分期和病理特征相似。2例（0.7%）患者发生局部复发。6例（2.1%）患者发生异时性病变，其中4例位于先前进行同步息肉切除术的同一段。A组和B组息肉切除部位的异时性病变发生率相似，分别为1.1%（1/87）和1.5%（3/194）（p = 0.795）。
在新诊断癌症的情况下，同步息肉切除术后的恶性种植仍未得到证实。即使确实发生了肿瘤种植，发生率可能也很低。
