Division of Colorectal Surgery, Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
University of Southern California Keck School of Medicine, Los Angeles, CA, 90033, USA.
Surg Endosc. 2022 Mar;36(3):2121-2128. doi: 10.1007/s00464-021-08499-7. Epub 2021 Apr 22.
"Endoscopically unresectable" benign polyps identified during screening colonoscopy are often referred for segmental colectomy. Application of advanced endoscopic techniques can increase endoscopic polyp resection, sparing patients the morbidity of colectomy. This retrospective case-control study aimed to evaluate the success of colon preserving resection of "endoscopically unresectable" benign polyps using advanced endoscopic techniques including endoscopic mucosal resection, endoscopic submucosal dissection, endoluminal surgical intervention, full-thickness laparo-endoscopic excision, and combined endo-laparoscopic resection.
A prospectively maintained institutional database identified 95 patients referred for "endoscopically unresectable" benign polyps from 2015 to 2018. Cases were compared to 190 propensity score matched controls from the same database undergoing elective laparoscopic colectomy for other reasons. Primary outcome was rate of complete endoscopic polyp removal. Secondary outcomes included length of stay, unplanned 30-day readmission and reoperation, 30-day mortality, and post-procedural complications.
Advanced endoscopic techniques achieved complete polyp removal without colectomy in 66 patients (70%). Failure was most commonly associated with previously attempted endoscopic resection and occult malignancy. Compared with matched colectomy controls, endoscopic polyp resection resulted in significantly shorter hospital length of stay (1.13 ± 2.41 vs 3.89 ± 4.57 days; p < 0.001), lower unplanned 30-day readmission (1.1% vs 7.7%; p < 0.05), and fewer postoperative complications (4.2% vs 33.9%; p < 0.001). Unplanned 30-day reoperation (2.1% vs 4.4%; p = 0.34) and 30-day mortality (0% vs 0.6%; p = 0.75) trended lower.
Endoscopic resection of complex polyps can be highly successful, and it is associated with favorable outcomes and decreased morbidity when compared with segmental colon resection. Attempting colon preservation using these techniques is warranted.
在筛查性结肠镜检查中发现的“内镜下不可切除”的良性息肉常被推荐进行节段性结肠切除术。应用先进的内镜技术可以增加内镜下息肉切除术的成功率，使患者免于结肠切除术的发病率。本回顾性病例对照研究旨在评估使用包括内镜黏膜切除术、内镜黏膜下剥离术、腔内手术干预、全层腹腔镜下切除和联合内镜腹腔镜切除在内的先进内镜技术对“内镜下不可切除”的良性息肉进行结肠保留切除的成功率。
通过前瞻性维护的机构数据库，从 2015 年至 2018 年确定了 95 例因“内镜下不可切除”的良性息肉而转诊的患者。将这些病例与来自同一数据库的 190 例因其他原因接受择期腹腔镜结肠切除术的倾向评分匹配对照进行比较。主要结局是完全内镜下息肉切除的比例。次要结局包括住院时间、30 天无计划再入院和再手术、30 天死亡率和术后并发症。
66 例（70%）患者采用先进的内镜技术成功地进行了息肉切除，而无需进行结肠切除术。失败最常见于先前尝试的内镜切除和隐匿性恶性肿瘤。与匹配的结肠切除术对照组相比，内镜息肉切除术导致住院时间明显缩短（1.13±2.41 天 vs. 3.89±4.57 天；p<0.001），30 天无计划再入院率较低（1.1% vs. 7.7%；p<0.05），术后并发症更少（4.2% vs. 33.9%；p<0.001）。30 天无计划再手术（2.1% vs. 4.4%；p=0.34）和 30 天死亡率（0% vs. 0.6%；p=0.75）也较低。
复杂息肉的内镜切除可以非常成功，与节段性结肠切除术相比，它具有良好的结果和降低的发病率。使用这些技术尝试结肠保留是合理的。
