Krutsri Chonlada, Toyonaga Takashi, Ishida Tsukasa, Hoshi Namiko, Baba Shinichi, Miyajima Nelson Tomio, Kodama Yuzo
Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Endosc Int Open. 2019 Aug;7(8):E949-E954. doi: 10.1055/a-0903-2403. Epub 2019 Jul 24.
Patients who have undergone colorectal surgery for resection of cancer and benign lesions are at risk for recurrent, residual, or metachronous lesions at the anastomosis site. Surgical resection of such lesions is difficult because of adhesions, and a stoma may be required as there are risks for leakage after resection. The feasibility and safety of endoscopic submucosal dissection (ESD) for these lesions remain unknown. Therefore, this case series aimed to examine the feasibility and safety of ESD by evaluating the clinical outcomes. We retrospectively investigated five patients who underwent ESD by a single expert for superficial neoplastic lesions at the anastomosis site after previous colorectal surgery. R0 resections were achieved for all lesions. Mean procedure time was 160.6 minutes. Mean dimensions of the resected specimen and tumor were 52.4 mm and 31.8mm, respectively. None of the patients had complications or recurrence after surveillance colonoscopy 1-year post-resection. In an expert's hands, ESD at the anastomosis site might be feasible minimally invasive treatment for superficial neoplastic lesions.
因癌症和良性病变接受结直肠手术切除的患者，吻合口部位存在复发性、残留性或异时性病变的风险。由于粘连，此类病变的手术切除困难，且切除后存在渗漏风险，可能需要造口。内镜黏膜下剥离术（ESD）治疗这些病变的可行性和安全性尚不清楚。因此，本病例系列旨在通过评估临床结果来检验ESD的可行性和安全性。我们回顾性调查了5例患者，这些患者曾接受结直肠手术，术后吻合口部位出现浅表肿瘤性病变，由一名专家对其进行ESD治疗。所有病变均实现R0切除。平均手术时间为160.6分钟。切除标本和肿瘤的平均尺寸分别为52.4毫米和31.8毫米。切除术后1年的结肠镜监测中，所有患者均未出现并发症或复发。在专家手中，吻合口部位的ESD可能是治疗浅表肿瘤性病变的可行的微创治疗方法。
