内镜黏膜下剥离术后追加手术治疗结直肠肿瘤：53 例回顾性研究。

Additional surgery after endoscopic submucosal dissection for colorectal cancer: a review of 53 cases.

机构信息

Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada-shi, Osaka, 596-8522, Japan.

出版信息

Int J Colorectal Dis. 2019 Oct;34(10):1723-1729. doi: 10.1007/s00384-019-03370-7. Epub 2019 Sep 2.

DOI:10.1007/s00384-019-03370-7

PMID:31478085

Abstract

BACKGROUND

Endoscopic submucosal dissection (ESD) allows the en bloc resection of tumors and is particularly indicated for T1 colorectal cancer. The number of patients undergoing additional surgery after colorectal ESD is increasing. This study aimed to retrospectively evaluate the efficacy and long-term outcomes in patients with additional surgery.

METHODS

Of 1018 patients who underwent colorectal ESD in our hospital between February 2010 and July 2018, 53 patients who underwent additional surgery in our hospital were retrospectively analyzed and investigated for their clinicopathological characteristics. The need for additional surgery was determined by a pathological examination according to the guideline [1].

RESULTS

In total, 53 patients (24 men, 29 women; mean age, 68.2 years; mean tumor diameter, 30.5 mm) were included. Laparoscopic surgery was performed in 47 (88.7%) patients. Liver metastases were preoperatively observed in one patient, for whom hepatectomy was simultaneously performed. All procedures included pathological R0 resection. Postoperative complications occurred in 9 (17.0%) patients. There were no complications requiring reoperation. Fifteen (28.3%) patients had a positive vertical margin; of these patients, residual tumor was observed in the resected specimens of two (13.3%) patients. Eight patients (15.1%) had lymph node metastasis (LNM): four (25.0%) and four (10.8%) of 16 and 37 patients with and without vascular invasion, respectively. Eleven patients (20.8%) had grade 2 or 3 tumor budding, and four (36.4%) of these had LNM. Postoperative recurrence was observed in two (3.8%) patients.

CONCLUSION

Additional surgery after ESD for T1 colorectal cancer was effective and had good long-term outcomes.

摘要

背景

内镜黏膜下剥离术（ESD）可整块切除肿瘤，尤其适用于 T1 结直肠癌。越来越多的患者在接受结直肠 ESD 后需要追加手术。本研究旨在回顾性评估追加手术后患者的疗效和长期预后。

方法

对 2010 年 2 月至 2018 年 7 月在我院接受结直肠 ESD 的 1018 例患者进行回顾性分析，对其中 53 例在我院追加手术的患者进行临床病理特征分析。根据指南[1]，通过病理检查确定是否需要追加手术。

结果

共纳入 53 例患者（男 24 例，女 29 例；平均年龄 68.2 岁；肿瘤平均直径 30.5mm）。47 例（88.7%）患者行腹腔镜手术。1 例患者术前发现肝转移，同时行肝切除术。所有手术均行病理 R0 切除。9 例（17.0%）患者发生术后并发症。无需要再次手术的并发症。15 例（28.3%）患者存在垂直切缘阳性；其中 2 例（13.3%）患者在切除标本中发现残留肿瘤。8 例（15.1%）患者发生淋巴结转移（LNM）：无血管侵犯的 16 例和有血管侵犯的 37 例患者中分别有 4 例（25.0%）和 4 例（10.8%）发生 LNM。11 例（20.8%）患者肿瘤芽生分级为 2 级或 3 级，其中 4 例（36.4%）发生 LNM。2 例（3.8%）患者术后复发。