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结直肠癌内镜或手术切除后内镜监测:欧洲胃肠道内镜学会(ESGE)和欧洲消化肿瘤学会(ESDO)指南。

Endoscopic surveillance after surgical or endoscopic resection for colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Digestive Oncology (ESDO) Guideline.

机构信息

Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy.

Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.

出版信息

Endoscopy. 2019 Mar;51(3):266-277. doi: 10.1055/a-0831-2522. Epub 2019 Feb 5.

Abstract

1:  We recommend post-surgery endoscopic surveillance for CRC patients after intent-to-cure surgery and appropriate oncological treatment for both local and distant disease.Strong recommendation, low quality evidence. 2:  We recommend a high quality perioperative colonoscopy before surgery for CRC or within 6 months following surgery.Strong recommendation, low quality evidence. 3:  We recommend performing surveillance colonoscopy 1 year after CRC surgery.Strong recommendation, moderate quality evidence. 4:  We do not recommend an intensive endoscopic surveillance strategy, e. g. annual colonoscopy, because of a lack of proven benefit.Strong recommendation, moderate quality evidence. 5:  After the first surveillance colonoscopy following CRC surgery, we suggest the second colonoscopy should be performed 3 years later, and the third 5 years after the second. If additional high risk neoplastic lesions are detected, subsequent surveillance examinations at shorter intervals may be considered.Weak recommendation, low quality evidence. 6:  After the initial surveillance colonoscopy, we suggest halting post-surgery endoscopic surveillance at the age of 80 years, or earlier if life-expectancy is thought to be limited by comorbidities.Weak recommendation, low quality evidence. 7:  In patients with a low risk pT1 CRC treated by endoscopy with an R0 resection, we suggest the same endoscopic surveillance schedule as for any CRC.Weak recommendation, low quality evidence.

摘要
  1. 我们建议对有治愈意图的 CRC 患者在手术后进行内镜监测,并对局部和远处疾病进行适当的肿瘤治疗。强烈推荐,低质量证据。

  2. 我们建议对 CRC 患者进行高质量的围手术期结肠镜检查,或在手术后 6 个月内进行。强烈推荐,低质量证据。

  3. 我们建议在 CRC 手术后 1 年进行监测结肠镜检查。强烈推荐,中等质量证据。

  4. 我们不建议采用强化内镜监测策略,例如每年进行结肠镜检查,因为缺乏已证实的获益。强烈推荐,中等质量证据。

  5. 在 CRC 手术后的第一次监测结肠镜检查之后,我们建议第二次结肠镜检查应在 3 年后进行,第三次结肠镜检查应在第二次之后 5 年进行。如果发现额外的高危肿瘤性病变,可能需要考虑缩短后续监测检查的间隔。弱推荐,低质量证据。

  6. 在初始监测结肠镜检查之后,我们建议在 80 岁时停止手术后的内镜监测,或者如果预期因合并症而导致预期寿命有限,则更早停止。弱推荐,低质量证据。

  7. 在接受内镜下 R0 切除治疗的低危 pT1 CRC 患者中,我们建议采用与任何 CRC 相同的内镜监测方案。弱推荐,低质量证据。

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