单一西方中心 601 例结直肠内镜黏膜下剥离术的结果：右半结肠位置仍为主要关注点吗？
Outcomes of 601 Colorectal Endoscopic Submucosal Dissections in a Single Western Center: Is Right Colon Location Still a Major Concern?
机构信息
Center of Bowel Treatment, Brzeziny.
Departments of General and Colorectal Surgery.
出版信息
Surg Laparosc Endosc Percutan Tech. 2021 May 3;31(5):578-583. doi: 10.1097/SLE.0000000000000940.
BACKGROUND
Endoscopic submucosal dissection (ESD), as a minimally invasive procedure for removal of early gastrointestinal neoplasms, is a standard approach in Asian countries. Outcomes of ESD in Western European countries significantly differ, which makes it more difficult to apply this procedure to daily-basis clinical routine. The aim of this study is to analyze the safety and efficiency of colorectal ESD based on a large series of cases performed by a single operator after finishing the learning curve period in a western referral center.
MATERIALS AND METHODS
We retrospectively studied 601 patients who underwent ESD procedure for colorectal neoplasm from January 2016 to December 2019 in a tertiary colorectal ESD center in Poland.
RESULTS
The overall en bloc resection was achieved in 88.02%. Complete histologic resection rate (R0) was reported at a level of 86.36%. Lesions located in the right colon were characterized by statistically lower en bloc, R0 resection, and success rate (73.95%, 71.43%, 69.75%, respectively). In 9.82% (n=59) of cases, the ESD procedure-related complications have been observed. Post-ESD bleeding occurred in 23 patients (3.83%) and perforation in 32 patients (5.32%). Twenty-seven patients were treated endoscopically (4.49%) and 5 required surgery (0.83%). Analysis of complications showed that tumors located within the right colon were characterized by the highest perforation rate at 10.92%. Within the rectum there were minimal number of perforations (2.69%), whereas the bleeding rate was 4.48%.
CONCLUSIONS
Our results represent the largest material concerning ESD of colorectal lesions in the West and show that ESD is characterized by a high rate of successful resections with a low risk of complications. Thus, confirming that it is possible to obtain results similar to Asian centers and that colorectal ESD procedures can be implemented in clinical routine in western countries. Nevertheless, ESD in the right colon is still related with high rate of complications, so qualification for the ESD procedure should be very careful and discussed with the patient and should be performed by an experienced endoscopist after the learning curve.
背景
内镜黏膜下剥离术（ESD）作为一种微创方法，用于切除早期胃肠道肿瘤，在亚洲国家是一种标准方法。然而，在西欧国家，ESD 的结果存在显著差异，这使得将该手术更难应用于日常临床常规。本研究的目的是分析在一个西方转诊中心完成学习曲线后，由一位经验丰富的内镜医生对大量病例进行结直肠 ESD 的安全性和有效性。
材料和方法
我们回顾性研究了 2016 年 1 月至 2019 年 12 月期间在波兰一家三级结直肠 ESD 中心接受 ESD 治疗的 601 例结直肠肿瘤患者。
结果
整块切除率为 88.02%。完全组织学切除率（R0）为 86.36%。右半结肠的病变整块切除率、R0 切除率和成功率分别为 73.95%、71.43%和 69.75%，统计学差异显著。9.82%（n=59）的病例观察到 ESD 相关并发症。23 例（3.83%）出现 ESD 后出血，32 例（5.32%）出现穿孔。27 例患者接受内镜治疗（4.49%），5 例患者需要手术（0.83%）。并发症分析显示，右半结肠肿瘤穿孔率最高，为 10.92%。直肠穿孔率最低，为 2.69%，而出血率为 4.48%。
结论
我们的结果代表了西方最大的结直肠病变 ESD 材料，表明 ESD 具有高成功率和低并发症风险。因此，证实了在西方国家也可以获得类似于亚洲中心的结果，并且结直肠 ESD 手术可以在临床常规中实施。然而，右半结肠的 ESD 仍然与高并发症率相关，因此应非常谨慎地进行 ESD 资格评估，并与患者进行讨论，应由经验丰富的内镜医生在学习曲线后进行操作。
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