Høgh Anders, Deding Ulrik, Bjørsum-Meyer Thomas, Buch Niels, Baatrup Gunnar
Department of Surgery, Odense University Hospital, Svendborg, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Surg Endosc. 2022 Nov;36(11):8195-8201. doi: 10.1007/s00464-022-09263-1. Epub 2022 May 10.
Segmental resection of the colon or rectum for cancer is major surgery with substantial procedure-related morbidity and mortality. A steep increase in the frequency of early cancer and advanced adenoma detection has been evident these late years. Introducing more minimal invasive resection techniques may decrease procedure-related complications and mortality. We aimed to describe the results from introducing endoscopic full-thickness resection (eFTR) in a unit specialized in advanced endoscopic resection of colon neoplasias. Primary outcomes were R0 resection rate and complications.
endoscopic full-thickness resection was introduced in our unit in 2017. Patients were referred for eFTR based on indications: (i) completion of resection after unexpected cancer, (ii) suspicion of or clinically confirmed early cancer (T1) without signs of dissemination, or (iii) adenomas not suitable for other endoscopic resection techniques due to difficult position or recurrence. Data on eFTR procedures and follow-up were retrieved from patient journals.
Thirty-seven eFTR procedures were commenced in the period of March 2017 until June 2020, and one of these was abandoned. The overall R0 resection rate was 83.3%. In subgroups of indications i-iii, it was 87.5, 80.0, and 80.0%, respectively. Three perforations and one case of late bleeding occurred. One patient died within 30 days due to late perforation. Six technical failures were evident including operator-induced failures. Five of the technical failures occurred in the first half of the procedures indicating the learning curve of the endoscopist.
Implementation of the eFTR procedure has been largely successful, especially in patients referred for completion of resection after unexpected cancer. Complication rates were acceptable, and the technique and quality increased significantly during the study. Careful selection of patients for eFTR is crucial for achieving successful resection. Size and position of lesion seem more important than indication. eFTR is not effective for lesions > 30 mm.
结肠癌或直肠癌的节段性切除是一项大型手术，会带来与手术相关的较高发病率和死亡率。近年来，早期癌症和晚期腺瘤的检出率急剧上升。引入更多的微创切除技术可能会降低与手术相关的并发症和死亡率。我们旨在描述在一个专门进行结肠肿瘤高级内镜切除的科室引入内镜全层切除术（eFTR）的结果。主要结局指标为R0切除率和并发症。
2017年我们科室引入了内镜全层切除术。根据以下指征将患者转诊进行eFTR：（i）意外癌症后切除完成；（ii）怀疑或临床确诊为无播散迹象的早期癌症（T1）；或（iii）因位置困难或复发而不适合其他内镜切除技术的腺瘤。从患者病历中获取eFTR手术及随访数据。
2017年3月至2020年6月期间共开展了37例eFTR手术，其中1例手术放弃。总体R0切除率为83.3%。在指征i - iii的亚组中，分别为87.5%、80.0%和80.0%。发生了3例穿孔和1例迟发性出血。1例患者因迟发性穿孔在30天内死亡。明显存在6例技术失败，包括操作者导致的失败。其中5例技术失败发生在手术的前半段，表明内镜医师存在学习曲线。
eFTR手术的实施在很大程度上是成功的，特别是对于因意外癌症后切除完成而转诊的患者。并发症发生率是可接受的，并且在研究期间该技术和质量有显著提高。仔细选择适合eFTR的患者对于实现成功切除至关重要。病变的大小和位置似乎比指征更重要。eFTR对大于30mm的病变无效。
