Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peking, China.
National Clinical Research Center for Digestive Diseases, Beijing, Peking, China.
Expert Rev Gastroenterol Hepatol. 2022 Jun;16(6):511-519. doi: 10.1080/17474124.2022.2085555. Epub 2022 Jun 13.
Colorectal cancer holds a high morbidity and mortality rate. As a common method for colorectal cancer detection, colonoscopy has difficulty in passing through the malignant stenosis in patients with obstructive colorectal cancer, which results in incomplete detection and missed diagnosis. The missed synchronous lesions increase the risk of metachronous cancer. Therefore, detecting proximal synchronous lesions in patients with obstructive colorectal cancer should be appreciated before operation.
This review evaluates related literature, aiming at providing clinicians with more ideas and attention for detecting proximal synchronous lesions in patients with obstructive colorectal cancer.
In patients with obstructive colorectal cancer, missed diagnosis of lesions proximal to the obstruction may lead to metachronous colorectal cancer. Except for preoperative colonoscopy which is difficult to pass through malignant stenosis, other methods that can evaluate proximal colon segment are critical. This article introduced several preoperative, intraoperative and postoperative measures for synchronous lesions detection. The choice of methods should base on patients' conditions, aiming at a high diagnostic yield and low risk. Early detection and resection of synchronous lesions in the proximal section of malignant obstruction are expected to minimize the risk of metachronous colorectal cancer and even effect follow-up treatment strategy, which deserves the attention of clinicians.
结直肠癌发病率和死亡率均较高。结肠镜检查作为结直肠癌的常用检测方法，在伴有梗阻的结直肠癌患者中，由于难以通过恶性狭窄段，存在检测不完全和漏诊的情况，增加了同时性病变的漏诊风险，进而增加了异时性癌症的发生风险。因此，在术前应重视检测伴有梗阻的结直肠癌患者的近端同时性病变。
本综述评估了相关文献，旨在为临床医生提供更多检测伴有梗阻的结直肠癌患者近端同时性病变的思路和关注。
在伴有梗阻的结直肠癌患者中，对梗阻近端病变的漏诊可能导致结直肠癌的异时性发生。除了术前难以通过恶性狭窄段的结肠镜检查外，其他可评估近端结肠节段的方法至关重要。本文介绍了几种术前、术中和术后检测同时性病变的方法。方法的选择应基于患者的情况，以获得较高的诊断率和较低的风险。早期检测和切除恶性梗阻近端的同时性病变，有望最大限度地降低异时性结直肠癌的风险，甚至影响后续治疗策略，这值得临床医生的关注。
