Fukami Norio
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
Gastrointest Endosc Clin N Am. 2019 Oct;29(4):675-685. doi: 10.1016/j.giec.2019.06.007. Epub 2019 Jul 30.
Endoscopic resection for large colorectal lesion is effective and cost-saving than surgery. Piecemeal resections are often effective if applied meticulously but endoscopic submucosal dissection (ESD) allows meritorious removal of large lesions in one piece. For rectal lesions, transanal endoscopic microsurgery or transanal minimally invasive surgery offers more radical transmural resection but ESD is also effective for removal of complex rectal lesions. Surgical resection with lymph node dissection is the gold standard for invasive cancer; however, the management of low-risk early-stage colorectal cancer is worth debating. Treatment selection for large colorectal lesions is discussed based on lesion factor and treatment outcomes.
对于大肠大病变，内镜下切除比手术更有效且节省成本。如果操作细致，分块切除通常有效，但内镜黏膜下剥离术（ESD）能完整切除较大病变。对于直肠病变，经肛门内镜显微手术或经肛门微创手术能实现更彻底的全层切除，但ESD对于切除复杂直肠病变也有效。伴有淋巴结清扫的手术切除是浸润性癌的金标准；然而，低风险早期大肠癌的治疗管理值得探讨。基于病变因素和治疗结果讨论了大肠大病变的治疗选择。
