Parihar V, Sopena-Falco J, Leung E, Benz E, Cooney A, Keohane J, Sengupta S
Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland.
Ir Med J. 2020 Jan 16;113(1):7.
Aims To determine the completeness of polyp resection (i.e. achieving an R0 margin) and its relation with Endoscopists, histopathologist, size, location and technique of polypectomy in an NSS cohort. The definition of R0 margin is complete macroscopic resection with a negative microscopic margin at polypectomy. Method NCCS (National Colon Cancer Screening) colonoscopies are offered to bowel cancer screening patients after a positive faecal immunochemical test (FIT) test in a Joint Advisory Group (JAG) accredited Gastrointestinal Endoscopy centre. We histologically evaluated the polyp margins for complete resection, which was defined as the absence of adenomatous or hyperplastic tissue in the resected polyp margins in a cohort of faecal immunochemical test positive patients. Results A total of 186 consecutive NCCS colonoscopies out of a total of 542 performed between 2013 and 2017 were included in this study. Of the polyps excised 152(27%) had a R0 margin histologically, and 30(5%) had involvement of the margin. Surprisingly in 373(67%) of polyps pathologists were unable to assess the margin. Conclusion Achieving an R0 margin should be a key performance indicator for endoscopists performing polypectomy. At the same time more studies on polyp margins are recommended.
目的确定息肉切除的完整性（即实现R0切缘）及其与内镜医师、组织病理学家、息肉大小、位置和切除技术在全国筛查队列中的关系。R0切缘的定义是息肉切除时肉眼切除完整且显微镜下切缘阴性。方法在联合咨询小组（JAG）认可的胃肠内镜中心，对粪便免疫化学检测（FIT）呈阳性的肠癌筛查患者进行全国结肠直肠癌筛查（NCCS）结肠镜检查。我们对息肉边缘进行组织学评估以确定是否完全切除，完全切除的定义是在粪便免疫化学检测呈阳性的患者队列中，切除的息肉边缘不存在腺瘤性或增生性组织。结果在2013年至2017年间进行的542例结肠镜检查中，本研究共纳入了186例连续的NCCS结肠镜检查。在切除的息肉中，152例（27%）组织学上有R0切缘，30例（5%）切缘受累。令人惊讶的是，在373例（67%）息肉中，病理学家无法评估切缘。结论实现R0切缘应是进行息肉切除术的内镜医师的关键绩效指标。同时，建议对息肉切缘进行更多研究。
