Huang Emily S, Chumfong Isabelle T, Alkoraishi Ahmed S, Munroe Craig A
Department of Surgery, The Ohio State University, Columbus, Ohio.
Department of Surgery, University of California San Francisco, San Francisco, California.
J Surg Res. 2020 Aug;252:89-95. doi: 10.1016/j.jss.2020.02.006. Epub 2020 Apr 8.
Surgical resection is the gold standard in the treatment of neoplasia involving the appendiceal orifice (Ao). Endoscopic mucosal resection (EMR) of adenomas involving the Ao can be challenging because of the risk of appendicitis, perforation, or incomplete resection. Surgical resection of Ao lesions is limited by the difficulty of ensuring a negative lateral margin without compromising the ileocecal valve and usually necessitates ileocecal resection. Although combined endoscopic and laparoscopic surgery has become more widely accepted for a variety of conditions, a structured approach to lesions involving the Ao has yet to be described. We describe a novel approach to the treatment of periappendiceal, cecal, and appendiceal adenomas-and present an algorithm to guide decision-making regarding the application of these techniques.
All patients referred to our therapeutic endoscopy practice with tumors involving the Ao between August 2013 and July 2017 were included. Based on tumor size and involvement of the os, patients were either referred for extended laparoscopic appendectomy (ELA), EMR, or a combined approach.
In total, 47 patients were included; 25 patients underwent EMR only, 13 patients underwent ELA only, and nine patients underwent combined resection. Two patients undergoing EMR had postpolypectomy syndrome. One EMR-only patient with a positive lateral margin was referred for appendectomy, but declined. No patient required ileocecectomy. Pathologic examination revealed a high rate of sessile serrated adenoma (SSA; 36%).
Our results introduce a decision algorithm and suggest that EMR combined with ELA is a safe and curative technique for the treatment of large cecal adenomas involving the Ao.
手术切除是治疗累及阑尾开口（Ao）的肿瘤的金标准。由于存在阑尾炎、穿孔或切除不完全的风险，对累及Ao的腺瘤进行内镜黏膜切除术（EMR）具有挑战性。Ao病变的手术切除受到确保切缘阴性而不影响回盲瓣的难度限制，通常需要进行回盲部切除。尽管内镜与腹腔镜联合手术已在多种情况下被更广泛地接受，但针对累及Ao的病变的结构化治疗方法尚未见报道。我们描述了一种治疗阑尾周围、盲肠和阑尾腺瘤的新方法，并提出一种算法以指导这些技术应用的决策制定。
纳入2013年8月至2017年7月间因肿瘤累及Ao而转诊至我们治疗性内镜科室的所有患者。根据肿瘤大小和开口受累情况，患者被转诊接受扩大腹腔镜阑尾切除术（ELA）、EMR或联合治疗方法。
总共纳入47例患者；25例患者仅接受EMR，13例患者仅接受ELA，9例患者接受联合切除。2例接受EMR的患者出现息肉切除术后综合征。1例切缘阳性的仅接受EMR的患者被转诊进行阑尾切除术，但拒绝了。没有患者需要进行回盲部切除术。病理检查显示无蒂锯齿状腺瘤（SSA）的发生率很高（36%）。
我们的结果引入了一种决策算法，并表明EMR联合ELA是治疗累及Ao的大型盲肠腺瘤的一种安全且治愈性的技术。
