Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, South Korea.
Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Surg Endosc. 2019 Aug;33(8):2562-2571. doi: 10.1007/s00464-018-6550-0. Epub 2018 Oct 22.
Colorectal laterally spreading tumors (LSTs) are large, flat neoplasms that are usually treated using different endoscopic techniques based on their morphology, size, and histology. The aim of this study was to evaluate the clinical outcomes of LSTs with advanced histology treated by endoscopic resection.
A total of 246 LSTs with advanced histology [i.e., high-grade dysplasia (HGD) and adenocarcinoma (AC)] treated by endoscopic resection [i.e., endoscopic mucosal resection (EMR), EMR-precutting (EMR-P), and endoscopic submucosal dissection (ESD)] were enrolled. Clinicopathological characteristics were collected by review of patient's medical records.
The en bloc resection and R0 resection rates were 75.6% and 85.0%, respectively. The bleeding and perforation rates were 10.2% and 2.4%, respectively. The frequency of cancerous pit pattern and bleeding was significantly higher in LSTs with AC than in LSTs with HGD. The R0 resection rate in LSTs with HGD was significantly higher than that in LSTs with AC. The frequency of cancerous pit patterns in LST cases with submucosal AC was significantly higher than those with intramucosal AC. The mean size of the LSTs was significantly larger in ESD group than in EMR or EMR-P groups. The frequencies of nodular mixed subtype, cancerous pit patterns, and en bloc resection rates were significantly higher in the ESD group than in the EMR or EMR-P groups. However, the frequency of perforation was significantly higher in EMR-P group than in EMR or ESD groups.
These results indicate that ESD is a more acceptable treatment approach for resection of colorectal LSTs of larger size, with nodular mixed subtype, having a cancerous pit pattern or AC, using either en bloc or curative resection methods, compared to EMR or EMR-P procedures.
结直肠侧向平坦型肿瘤（LSTs）是大型平坦型肿瘤，通常根据其形态、大小和组织学采用不同的内镜技术进行治疗。本研究旨在评估内镜下切除高级别组织学 LST 的临床结果。
共纳入 246 例高级别组织学（即高级别异型增生[HGD]和腺癌[AC]）的 LST 患者，采用内镜下切除[即内镜黏膜切除术（EMR）、EMR-预切开术（EMR-P）和内镜黏膜下剥离术（ESD）]治疗。通过回顾患者的病历收集临床病理特征。
整块切除率和 R0 切除率分别为 75.6%和 85.0%。出血和穿孔的发生率分别为 10.2%和 2.4%。AC 型 LST 的癌性凹陷模式和出血的发生率明显高于 HGD 型 LST。HGD 型 LST 的 R0 切除率明显高于 AC 型 LST。黏膜下 AC 型 LST 的癌性凹陷模式的发生率明显高于黏膜内 AC 型 LST。ESD 组的 LST 平均大小明显大于 EMR 或 EMR-P 组。ESD 组的结节混合亚型、癌性凹陷模式和整块切除率的频率明显高于 EMR 或 EMR-P 组。然而，EMR-P 组的穿孔发生率明显高于 EMR 或 ESD 组。
与 EMR 或 EMR-P 相比，ESD 是一种更可接受的治疗方法，适用于切除较大的结直肠 LST，具有结节混合亚型、癌性凹陷模式或 AC，采用整块或治愈性切除方法。
