Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
Department of Gastroenterology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
Surg Endosc. 2022 Jan;36(1):196-205. doi: 10.1007/s00464-020-08255-3. Epub 2021 Jan 13.
Combined-Endoscopic-Laparoscopic-Surgery (CELS) was developed for benign colonic polyps, endoscopically unresectable, to avoid segmental colectomy. This observational study aims to compare surgical outcomes of endoscopically unresectable colonic polyps treated laparoscopically before and since the institutional introduction of CELS. Primary endpoint was postoperative morbidity and mortality; secondary endpoints were time of hospitalization and histopathological findings.
Charts of all patients with preoperative diagnosis of benign colonic tumors, treated laparoscopically at our institution from 1/2010 to 2/2020 were reviewed. Patients with polyps (1) affecting ileocecal valve, (2) occupying > 50% of the circumference, (3) ≥ 3 endoscopically unresectable polyps, (4) inflammatory bowel disease, (5) polyps within diverticular area post diverticulitis, (6) rectal polyps (7) foreseen impossibility of laparoscopy (8) preoperatively biopsy proven invasive adenocarcinoma were excluded. Group I consists of all patients potentially treatable by CELS but operated by laparoscopic colonic resection as CELS was not yet institutionally established. Group II includes all patients treated with CELS (since 11/2017).
One hundred-fifteen consecutive patients were reviewed. Applying exclusion criteria, twenty-three patients form group I and twenty-three group II (female 30.4%, median age 68 years). Groups distributed homogenously for age, BMI (body mass index) and polyps´ localization with most polyps (60.4%) localized in right colon; group II patients had significantly higher American Society of Anesthesiologists (ASA) score. Median operating time, hospital stay and morbidity were significantly less in group II. Postoperative morbidity occurred overall in 14 patients (30.4%), mostly Clavien-Dindo class I-II (26.1%) and significantly less in group II (p = 0.017), Clavien-Dindo III-IV distributed equally (one patient each group) without postoperative mortality. Definitive histopathology showed invasive adenocarcinoma in 8.3% without differences between groups. Two patients with invasive adenocarcinoma after CELS were advised for oncological resection.
CELS is safe and efficient to treat complex, benign colonic polyps by a complete minimal invasive laparoscopic approach. CELS showed better surgical outcomes with less morbidity, no mortality and appropriate pathological results avoiding unnecessary laparoscopic surgery with intestinal anastomosis.
联合内镜腹腔镜手术（CELS）是为了避免节段性结肠切除术而开发的，用于治疗内镜无法切除的良性结肠息肉。本观察性研究旨在比较在我们机构引入 CELS 之前和之后，经腹腔镜治疗内镜无法切除的结肠息肉的手术结果。主要终点是术后发病率和死亡率；次要终点是住院时间和组织病理学发现。
回顾了 2010 年 1 月至 2020 年 2 月期间在我院接受术前诊断为良性结肠肿瘤并接受腹腔镜治疗的所有患者的病历。排除了（1）影响回盲瓣的息肉，（2）占据肠腔周长超过 50%的息肉，（3）≥3 个内镜无法切除的息肉，（4）炎症性肠病，（5）憩室炎后憩室区域内的息肉，（6）直肠息肉，（7）预计无法进行腹腔镜手术，（8）术前活检证实为浸润性腺癌的患者。I 组包括所有理论上可通过 CELS 治疗但由于 CELS 尚未在机构内建立而接受腹腔镜结肠切除术的患者。II 组包括所有接受 CELS 治疗的患者（自 2017 年 11 月起）。
共回顾了 115 例连续患者。应用排除标准，23 例患者为 I 组，23 例患者为 II 组（女性 30.4%，中位年龄 68 岁）。两组在年龄、BMI（体重指数）和息肉定位方面分布均匀，大多数息肉（60.4%）位于右结肠；II 组患者的美国麻醉医师协会（ASA）评分显著较高。II 组的中位手术时间、住院时间和发病率明显较低。两组总体术后发病率为 14 例（30.4%），大多为 Clavien-Dindo Ⅰ-Ⅱ级（26.1%），且 II 组明显较低（p = 0.017），Clavien-Dindo Ⅲ-Ⅳ级发病率相同（每组各 1 例），无术后死亡。明确的组织病理学显示浸润性腺癌占 8.3%，两组之间无差异。两名接受 CELS 治疗的浸润性腺癌患者被建议接受肿瘤切除术。
CELS 通过完全微创腹腔镜方法安全有效地治疗复杂的良性结肠息肉。CELS 显示出更好的手术结果，发病率较低，死亡率为零，病理结果适当，避免了不必要的腹腔镜肠吻合术。
