Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain.
Department of Pathology, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain.
J Gastrointest Surg. 2019 Sep;23(9):1874-1883. doi: 10.1007/s11605-018-3980-x. Epub 2018 Oct 10.
Polypectomy is the gold standard for treating colorectal adenomas up to 2 cm in size. For larger lesions, various procedures ranging from endoscopy to transanal surgery can be performed and achieve varying results for en bloc resection and recurrence. There are no clear guidelines for dealing with involved resection margins. We assess the recurrence of rectal adenomas operated using TEM with full-thickness wall excision with or without free resection margins and define optimal endoscopic follow-up.
Observational study with prospective data collection, including patients undergoing TEM between 6/2004 and 11/2017, with definitive diagnosis of rectal adenoma. Data on epidemiological, preoperative, surgical, postoperative, pathological, and follow-up variables were recorded. Univariate analysis, follow-up risk function, and multivariate logistic regression analysis were performed to detect risk factors for recurrence.
TEM was indicated in 736 patients; 481 adenomas were identified in the preoperative biopsy, of which 95 were infiltrating adenocarcinomas (19.8%) in the definitive pathology study. With a minimum follow-up of 1 year, 372 patients were included. Pathology study showed free margins in 324 (87%). Recurrences were recorded in 15 patients (4%), up to 18 months in the free margins group and up to 24 months in the involved margins group. Thirteen patients with recurrence (86.6%) were treated with TEM. No predictors of recurrence were found in the multivariate analysis.
TEM is the technique of choice for treating rectal adenomas and recurrences, achieving a low relapse rate. Follow-up must be adapted to resection margins and should be extended to 24 months.
息肉切除术是治疗最大直径达 2cm 的结直肠腺瘤的金标准。对于更大的病变，可以采用从内镜下到经肛门手术等多种方法，这些方法在整块切除和复发方面效果不同。对于累及切缘的处理尚无明确指南。我们评估了使用全层壁切除的 TEM 治疗直肠腺瘤的复发情况，包括有或无游离切缘，并确定了最佳的内镜随访策略。
这是一项前瞻性数据收集的观察性研究，纳入了 2004 年 6 月至 2017 年 11 月期间接受 TEM 的患者，明确诊断为直肠腺瘤。记录了人口统计学、术前、手术、术后、病理和随访变量的数据。进行单因素分析、随访风险函数和多因素逻辑回归分析，以检测复发的危险因素。
TEM 适用于 736 例患者；术前活检中发现 481 个腺瘤，其中 95 个在最终病理研究中为浸润性腺癌（19.8%）。在至少 1 年的随访中，纳入了 372 例患者。病理研究显示 324 例（87%）游离切缘。在游离切缘组中，有 15 例患者（4%）记录到复发，最长复发时间为 18 个月，在累及切缘组中，最长复发时间为 24 个月。13 例（86.6%）复发患者接受了 TEM 治疗。多因素分析未发现复发的预测因素。
TEM 是治疗直肠腺瘤和复发的首选技术，复发率低。随访必须适应切缘，并应延长至 24 个月。
