Santos-Antunes João, Pioche Mathieu, Ramos-Zabala Felipe, Cecinato Paolo, Gallego Rojo Francisco J, Barreiro Pedro, Félix Catarina, Sferrazza Sandro, Berr Frieder, Wagner Andrej, Lemmers Arnaud, Figueiredo Ferreira Mariana, Albéniz Eduardo, Uchima Hugo, Küttner-Magalhães Ricardo, Fernandes Carlos, Morais Rui, Gupta Sunil, Martinho-Dias Daniel, Rios Elisabete, Faria-Ramos Isabel, Marques Margarida, Bourke Michael J, Macedo Guilherme
Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal.
Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal.
Endoscopy. 2023 Mar;55(3):235-244. doi: 10.1055/a-1906-8000. Epub 2022 Jul 21.
Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding and a significant rate of noncurative procedures is expected. We aimed to assess the rate of residual lesions after a noncurative ESD for colorectal cancer (CRC) and to establish predictive scores to be applied in the clinical setting. METHODS : Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with noncurative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. RESULTS : From 2255 colorectal ESDs, 381 (17 %) were noncurative, and 135 of these were performed in CRC lesions. A residual lesion was observed in 24 patients (18 %). Surgery was performed in 96 patients and 76 (79 %) had no residual lesion in the colorectal wall or in the lymph nodes. The residual lesion rate for sm1 cancers was 0 %, and for > sm1 cancers was also 0 % if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of a residual lesion in the wall were piecemeal resection, poor differentiation, and positive/indeterminate vertical margin (NC-Wall score). CONCLUSIONS : Lymphatic permeation or poor differentiation warrant surgery owing to their high risk of lymph node metastasis, mainly in > sm1 cancers. In the remaining cases, en bloc and R0 resections resulted in a low risk of residual lesions in the wall. Our scores can be a useful tool for the management of patients who undergo noncurative colorectal ESDs.
结直肠病变的内镜黏膜下剥离术（ESD）技术要求较高，预计非根治性手术的比例较高。我们旨在评估结直肠癌（CRC）非根治性ESD术后残留病变的发生率，并建立适用于临床的预测评分。
对连续性结直肠ESD进行回顾性多中心分析。纳入因CRC病变接受非根治性ESD治疗且接受了补充手术或至少一次随访内镜检查的患者。
在2255例结直肠ESD中，381例（17%）为非根治性，其中135例用于CRC病变。24例患者（18%）观察到残留病变。96例患者接受了手术，其中76例（79%）在结直肠壁或淋巴结中无残留病变。sm1期癌的残留病变率为0%，如果不存在其他危险因素，>sm1期癌的残留病变率也为0%。淋巴结转移的独立危险因素为分化差和淋巴管浸润（NC-Lymph评分）。壁内残留病变的危险因素为分片切除、分化差和垂直切缘阳性/不确定（NC-Wall评分）。
淋巴管浸润或分化差因其淋巴结转移风险高，主要在>sm1期癌中，需要进行手术。在其余病例中，整块切除和R0切除导致壁内残留病变的风险较低。我们的评分可为接受非根治性结直肠ESD的患者的管理提供有用的工具。
