Spychalski Michał, Skulimowski Aleksander, Nishimura Makoto, Dziki Adam
1 Department of General and Colorectal Surgery, Multidisciplinary Hospital Brzeziny , Brzeziny, Poland .
2 Department of Gastrointestinal Endoscopy, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology , Tokyo, Japan .
J Laparoendosc Adv Surg Tech A. 2019 Mar;29(3):366-373. doi: 10.1089/lap.2018.0429. Epub 2018 Oct 25.
Endoscopic submucosal dissection (ESD) is an acknowledged endoscopic technique for the management of early gastrointestinal neoplasia. The clinical experience and the research from the Eastern ESD centers show that experienced endoscopists can successfully treat even the most demanding recurrent colorectal lesions.
The aim of this study was to analyze the clinical outcomes of the management of recurrent colorectal lesions in comparison with those of primary lesions in the setting of high-volume European center.
A retrospective analysis of 298 cases (228 primary lesions and 70 recurrent lesions) performed by a single endoscopist was carried out. Evaluating learning curves for both primary and recurrent lesions, cumulative sum analysis was performed.
Primary lesions had ∼9% higher R0 resection rate (86.84% versus 78.51%). Yet, this difference did not reach statistical significance (P = .091). The presence of recurrent lesion and lengthy procedure (≥150 min) are risks factors of R1 resection, whereas rectal localization of the lesion was associated with lower risk of R1 resection. The cumulative R0 of 80% was achieved at 36th procedure in the primary lesions group, whereas for the recurrent lesions it was reached at 50th procedure (overall 229 procedures).
Our study underlines the importance of proper experience in ESD before the management of recurrent lesions. Even after the completion of high volume of primary lesions, first recurrent lesions can pose a challenge. Nevertheless, the final outcomes are promising, as the complications do not pose a serious risk to the patients and high R0 resection rate can be achieved in a reasonable timeframe.
内镜黏膜下剥离术（ESD）是一种公认的用于治疗早期胃肠道肿瘤的内镜技术。东方ESD中心的临床经验和研究表明，经验丰富的内镜医师甚至可以成功治疗最具挑战性的复发性结直肠病变。
本研究的目的是在欧洲大容量中心的背景下，分析复发性结直肠病变与原发性病变治疗的临床结果。
对由一名内镜医师进行的298例病例（228例原发性病变和70例复发性病变）进行回顾性分析。通过累积和分析评估原发性和复发性病变的学习曲线。
原发性病变的R0切除率高约9%（86.84%对78.51%）。然而，这种差异未达到统计学意义（P = 0.091）。复发性病变的存在和手术时间长（≥150分钟）是R1切除的危险因素，而病变位于直肠则与较低的R1切除风险相关。原发性病变组在第36例手术时达到80%的累积R0切除率，而复发性病变在第50例手术时达到（总共229例手术）。
我们的研究强调了在处理复发性病变之前，ESD方面具备适当经验的重要性。即使在完成大量原发性病变治疗后，首次复发性病变仍可能构成挑战。然而，最终结果是有希望的，因为并发症对患者不构成严重风险，并且可以在合理的时间内实现高R0切除率。
