一种针对直肠的选择性切除算法可优化大型无蒂直肠息肉的肿瘤学治疗效果。
A Rectum-Specific Selective Resection Algorithm Optimizes Oncologic Outcomes for Large Nonpedunculated Rectal Polyps.
作者信息
Shahidi Neal, Vosko Sergei, Gupta Sunil, Whitfield Anthony, Cronin Oliver, O'Sullivan Timothy, van Hattem W Arnout, Sidhu Mayenaaz, Tate David J, Lee Eric Y T, Burgess Nicholas, Williams Stephen J, Bourke Michael J
机构信息
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia; Division of Gastroenterology, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
出版信息
Clin Gastroenterol Hepatol. 2023 Jan;21(1):72-80.e2. doi: 10.1016/j.cgh.2022.04.021. Epub 2022 May 6.
BACKGROUND AND AIMS
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are complementary techniques for large (≥20 mm) nonpedunculated rectal polyps (LNPRPs). A mechanism for appropriate technique selection has not been described.
METHODS
We evaluated the performance of a selective resection algorithm (SRA) (August 2017 to April 2021) compared with a universal EMR algorithm (UEA) (July 2008 to July 2017) for LNPRPs within a prospective observational study. In the SRA, LNPRPs with features of superficial submucosal invasive cancer (SMIC) (<1000 μm; Kudo pit pattern Vi), or with an increased risk of SMIC (Paris 0-Is or 0-IIa+Is nongranular, 0-IIa+Is granular with a dominant nodule ≥10 mm) underwent ESD. The remaining LNPRPs underwent EMR. Algorithm performance was evaluated by SMIC identified after EMR, curative oncologic resection (R0 resection, superficial SMIC, absence of negative histologic features), technical success, adverse events, and recurrence at first surveillance colonoscopy.
RESULTS
A total of 480 LNPRPs were evaluated (290 UEA, 190 SRA). Median lesion size was 40 (interquartile range, 30-60) mm. SMIC was identified in 56 (11.7%) LNPRPs. Significant differences in SMIC after EMR (SRA 1 [1.0%] vs UEA 35 [12.1%]; P = .001) and curative oncologic resection (SRA n = 7 [33.3%] vs UEA n = 2 [5.7%]; P = .010) were identified. No significant differences in technical success or adverse events were identified (all P > .137). Among LNPRPs with SMIC amenable to curative oncologic resection and which underwent ESD, 100% (n = 7 of 7) were cured.
CONCLUSIONS
A rectum-specific SRA optimizes oncologic outcomes for LNPRPs and mitigates the risk of piecemeal resection of cancers.
背景与目的
内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）是治疗大型（≥20 mm）无蒂直肠息肉（LNPRP）的互补技术。尚未描述合适技术选择的机制。
方法
在一项前瞻性观察性研究中，我们评估了选择性切除算法（SRA）（2017年8月至2021年4月）与通用EMR算法（UEA）（2008年7月至2017年7月）治疗LNPRP的效果。在SRA中，具有浅表黏膜下浸润癌（SMIC）特征（<1000μm；工藤凹坑模式Vi）或SMIC风险增加（巴黎0-Is或0-IIa+Is非颗粒状，0-IIa+Is颗粒状且优势结节≥10mm）的LNPRP接受ESD治疗。其余LNPRP接受EMR治疗。通过EMR后识别的SMIC、根治性肿瘤切除（R0切除、浅表SMIC、无阴性组织学特征）、技术成功率、不良事件以及首次结肠镜监测时的复发情况评估算法性能。
结果
共评估了480个LNPRP（290个UEA，190个SRA）。病变大小中位数为40（四分位间距，30 - 60）mm。56个（11.7%）LNPRP中发现了SMIC。EMR后SMIC（SRA为1个[1.0%] vs UEA为35个[12.1%]；P = 0.001）和根治性肿瘤切除（SRA为7例[33.3%] vs UEA为2例[5.7%]；P = 0.010）存在显著差异。在技术成功率或不良事件方面未发现显著差异（所有P > 0.137）。在适合根治性肿瘤切除且接受ESD治疗的有SMIC的LNPRP中，100%（7例中的7例）治愈。
结论
特定于直肠的SRA可优化LNPRP的肿瘤学结局，并降低癌症分片切除的风险。
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