Department of Colorectal Surgery, King's College Hospital NHS Foundation Trust, London, UK; King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.
Department of Colorectal Surgery, King's College Hospital NHS Foundation Trust, London, UK.
Gastrointest Endosc. 2019 Jul;90(1):127-136. doi: 10.1016/j.gie.2019.01.031. Epub 2019 Feb 27.
Few large Western series examine risk factors for recurrence after endoscopic resection (ER) of large (≥20 mm) colorectal laterally spreading tumors. Recurrence beyond initial surveillance is seldom reported, and differences between residual/recurrent adenoma and late recurrence are not scrutinized. We report the incidence of recurrence at successive surveillance intervals, identify risk factors for recurrent/residual adenoma and late recurrence, and describe the outcomes of ER of recurrent adenomas.
Recurrence was calculated for successive surveillance periods after colorectal ER. Multiple logistic regression was used to identify independent risk factors for recurrent/residual adenoma and late recurrence (≥12 months).
Six hundred twenty colorectal ERs were performed, and 456 eligible patients (98%) had completed 3- to 6-month surveillance. Residual/recurrent adenoma (3-6 months) was detected in 8.3%, at 12 months in 6.1%, between 24 and 36 months in 6.4%, and after 36 months in 13.5%. Independent risk factors for residual/recurrent adenoma were piecemeal resection (odds ratio [OR], 13.0; P = .01), adjunctive argon plasma coagulation (OR, 2.4; P = .01), and lesion occupying ≥75% of the luminal circumference (OR, 5.6; P < .001) and for late recurrence were lesion size >60 mm (OR, 6.3; P < .001) and piecemeal resection (OR, 4.4; P = .04). Of 66 patients with recurrence, 5 required surgery, 8 left the treatment pathway, 20 are still receiving ER or surveillance, and 33 had ER with normal subsequent surveillance.
Recurrence occurs at successive periods of surveillance after ER even beyond 3 years. Aside from piecemeal resection, risk factors for residual/recurrent adenoma and late recurrence are different. Recurrence can be challenging to treat, but surgery is rarely required.
很少有大型的西方系列研究探讨内镜切除（ER）大型（≥20mm）结直肠侧向扩展肿瘤后复发的危险因素。很少有报道复发超过初始监测的情况，也没有仔细研究残留/复发性腺瘤和晚期复发之间的差异。我们报告了连续监测间隔的复发发生率，确定了残留/复发性腺瘤和晚期复发的独立危险因素，并描述了复发性腺瘤 ER 的结果。
计算结直肠 ER 后连续监测期间的复发率。使用多因素逻辑回归分析确定残留/复发性腺瘤和晚期复发（≥12 个月）的独立危险因素。
共进行了 622 例结直肠 ER，456 例符合条件的患者（98%）完成了 3-6 个月的监测。3-6 个月时发现残留/复发性腺瘤（8.3%），12 个月时为 6.1%，24-36 个月时为 6.4%，36 个月后为 13.5%。残留/复发性腺瘤的独立危险因素是分片切除（比值比[OR]，13.0；P=0.01）、辅助氩等离子凝固（OR，2.4；P=0.01）和病变占据管腔周长的≥75%（OR，5.6；P<0.001），晚期复发的独立危险因素是病变大小>60mm（OR，6.3；P<0.001）和分片切除（OR，4.4；P=0.04）。66 例复发患者中，5 例需要手术，8 例离开治疗途径，20 例仍接受 ER 或监测，33 例 ER 后监测正常。
ER 后即使超过 3 年也会在连续监测期间发生复发。除了分片切除外，残留/复发性腺瘤和晚期复发的危险因素也不同。复发性疾病的治疗具有挑战性，但很少需要手术。
