Richards W O, Webb W A, Morris S J, Davis R C, McDaniel L, Jones L, Littauer S
Ann Surg. 1987 Jun;205(6):665-72. doi: 10.1097/00000658-198706000-00008.
The subject of management of patients after endoscopic removal of cancerous adenomas is controversial. A retrospective review of 126 lesions in 121 patients who had had colonoscopic polypectomy of malignant lesions between 1971 and 1985 was used to determine the criteria for colon resection. Invasive cancer was identified in 80 patients, while 41 patients had carcinoma in situ. A synchronous colon cancer was found in five of the 121 patients. The patients who had carcinoma in situ had no evidence of residual tumor or metastatic disease on subsequent follow-up (colon resection in three patients and endoscopic surveillance in 38 patients). Of the 80 patients with invasive cancer, 44 had subsequent colon resection, and 34 of these had no evidence of tumor in the resected bowel or mesenteric lymph nodes. Ten patients had residual tumor, metastatic cancer to regional lymph nodes, or both. Each of the 10 had at least one of the following indications of inadequate resection or dissemination of disease to local lymph nodes (the first indication is a macroscopic evaluation, while the remaining four are all microscopic): incomplete excision, poorly differentiated tumor, invasion of the line of resection, invasion of the polyp stalk, and invasion of venous or lymphatic channels. Present recommendations for patient management after endoscopic removal of an invasive malignant adenoma should include colon resection with regional lymphadenectomy for patients with one or more of these five criteria. Patients without any of these risk factors should have early repeat endoscopic examination 3 months after initial polypectomy to evaluate the polypectomy site. Total colonoscopic examination is repeated at 1 year to ensure the surveillance program is begun with a colon without neoplasms.
内镜下切除癌性腺瘤后患者的管理问题存在争议。对1971年至1985年间接受结肠镜下恶性病变息肉切除术的121例患者的126个病变进行回顾性研究，以确定结肠切除的标准。80例患者被诊断为浸润性癌，41例患者为原位癌。121例患者中有5例发现同时性结肠癌。原位癌患者在随后的随访中没有残留肿瘤或转移性疾病的证据（3例患者接受了结肠切除，38例患者接受了内镜监测）。80例浸润性癌患者中，44例随后接受了结肠切除，其中34例在切除的肠段或肠系膜淋巴结中没有肿瘤证据。10例患者有残留肿瘤、区域淋巴结转移癌或两者皆有。这10例患者中的每一例都至少有以下一项提示切除不充分或疾病扩散至局部淋巴结的指标（第一个指标是宏观评估，其余四个均为微观评估）：切除不完全、肿瘤分化差、侵犯切除线、侵犯息肉蒂以及侵犯静脉或淋巴管。目前对于内镜下切除浸润性恶性腺瘤后患者管理的建议应包括，对于有这五项标准中一项或多项的患者，进行结肠切除并区域淋巴结清扫。没有任何这些危险因素的患者应在初次息肉切除术后3个月进行早期重复内镜检查，以评估息肉切除部位。1年后重复进行全结肠镜检查，以确保监测计划从无肿瘤的结肠开始。
