Patenotte Adrien, Yzet Clara, Wallenhorst Timothée, Subtil Fabien, Leblanc Sarah, Schaefer Marion, Walter Thomas, Lambin Thomas, Fenouil Tanguy, Lafeuille Pierre, Chevaux Jean-Baptiste, Legros Romain, Rostain Florian, Rivory Jérôme, Jacques Jérémie, Lépilliez Vincent, Pioche Mathieu
Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France.
Endoscopy. 2023 Feb;55(2):192-197. doi: 10.1055/a-1866-8080. Epub 2022 Jun 1.
Endoscopic submucosal dissection (ESD) is potentially a curative treatment for T1 colorectal cancer under certain conditions. The aim of this study was to evaluate the feasibility and effectiveness of ESD for lesions with a suspicion of focal deep invasion.
In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying a focal (< 15 mm) deep invasive pattern (FDIP) that were treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures).
124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 attempts (95.2 %) and, where possible, the en bloc and R0 resection rates were 95.8 % (115/120) and 76.7 % (92/120), respectively. Thirty-three resections (26.2 %) were for very low risk tumors, so considered curative, and 38 (30.2 %) were for low risk lesions. Noncurative R0 resections were for lesions with lymphatic or vascular invasion (LVI; n = 8), or significant budding (n = 9), and LVI + budding combination (n = 4).
ESD is feasible and safe for colorectal lesions with an FDIP ≤ 15 mm. It was curative in 26.6 % of patients and could be a valid option for a further 30.6 % of patients with low risk T1 cancers, especially for frail patients with co-morbidities.
在某些情况下，内镜下黏膜下剥离术（ESD）可能是T1期结直肠癌的一种根治性治疗方法。本研究的目的是评估ESD治疗疑似局灶性深度浸润病变的可行性和有效性。
在这项回顾性多中心研究中，纳入了连续接受ESD治疗的表现为局灶性（<15mm）深度浸润模式（FDIP）的结直肠肿瘤患者。我们排除了溃疡病变（巴黎III型）、有远处转移的病变和明显进展期肿瘤（肿瘤性狭窄）。
124例患者接受了126次针对FDIP病变的诊断性剥离尝试。126次尝试中有120次（95.2%）剥离可行，在可能的情况下，整块切除率和R0切除率分别为95.8%（115/120）和76.7%（92/120）。33例切除（26.2%）针对极低风险肿瘤，因此被视为根治性切除，38例（30.2%）针对低风险病变。非根治性R0切除适用于有淋巴管或血管侵犯（LVI；n = 8）、显著芽生（n = 9）以及LVI+芽生组合（n = 4）的病变。
ESD治疗FDIP≤15mm的结直肠病变是可行且安全的。26.6%的患者实现了根治，对于另外30.6%的低风险T1期癌症患者，尤其是伴有合并症的体弱患者，ESD可能是一种有效的选择。
