Rudnicki Yaron, Horesh Nir, Harbi Assaf, Lubianiker Barak, Green Eraan, Raveh Guy, Slavin Moran, Segev Lior, Gilshtein Haim, Khalifa Muhammad, Barenboim Alexander, Wasserberg Nir, Khaikin Marat, Tulchinsky Hagit, Issa Nidal, Duek Daniel, Avital Shmuel, White Ian
Meir Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel.
Sheba Medical Center, Department of General Surgery B and Organ Transplantation, Faculty of Medicine, Tel Aviv University, Ramat Gan 5265601, Israel.
J Clin Med. 2023 Jan 29;12(3):1032. doi: 10.3390/jcm12031032.
: Rectal polyps with low-grade dysplasia (LGD) can be removed by local excision surgery (LE). It is unclear whether these lesions pose a higher risk for recurrence and cancer development and might warrant an early repeat rectal endoscopy. This study aims to assess the rectal cancer rate following local excision of LGD rectal lesions. : A retrospective multicenter study including all patients that underwent LE for rectal polyps over a period of 11 years was conducted. Demographic, clinical, and surgical data of patients with LGD werecollected and analyzed. : Out of 274 patients that underwent LE of rectal lesions, 81 (30%) had a pathology of LGD. The mean patient age was 65 ± 11 years, and 52 (64%) were male. The mean distance from the anal verge was 7.2 ± 4.3 cm, and the average lesion was 3.2 ± 1.8 cm. Full thickness resection was achieved in 68 patients (84%), and four (5%) had involved margins for LGD. Nine patients (11%) had local recurrence and developed rectal cancer in an average time interval of 19.3 ± 14.5 months, with seven of them (78%) diagnosed less than two years after the initial LE. Seven of the nine patients were treated with another local excision, whilst one had a low anterior resection, and one was treated with radiation. The mean follow-up time was 25.3 ± 22.4 months. : Locally resected rectal polyps with LGD may carry a significant risk of recurring and developing cancer within two years. This data suggests patients should have a closer surveillance protocol in place.
低级别异型增生（LGD）的直肠息肉可通过局部切除手术（LE）切除。目前尚不清楚这些病变是否具有更高的复发和癌症发展风险，以及是否需要早期重复进行直肠内镜检查。本研究旨在评估LGD直肠病变局部切除术后的直肠癌发生率。
开展了一项回顾性多中心研究，纳入了在11年期间接受直肠息肉LE手术的所有患者。收集并分析了LGD患者的人口统计学、临床和手术数据。
在274例接受直肠病变LE手术的患者中，81例（30%）病理检查为LGD。患者的平均年龄为65±11岁，52例（64%）为男性。距肛缘的平均距离为7.2±4.3 cm，平均病变大小为3.2±1.8 cm。68例（84%）实现了全层切除，4例（5%）LGD切缘受累。9例（11%）出现局部复发并发展为直肠癌，平均时间间隔为19.3±14.5个月，其中7例（78%）在初次LE后不到两年被诊断出。9例患者中有7例接受了再次局部切除治疗，1例接受了低位前切除术，1例接受了放疗。平均随访时间为25.3±22.4个月。
局部切除的LGD直肠息肉可能在两年内有显著的复发和癌变风险。这些数据表明患者应有更密切的监测方案。
