Santos-Antunes João, Pioche Mathieu, Ramos-Zabala Felipe, Cecinato Paolo, Gallego Francisco, Barreiro Pedro, Mascarenhas André, Sferrazza Sandro, Berr Frieder, Wagner Andrej, Lemmers Arnaud, Ferreira Mariana Figueiredo, Albéniz Eduardo, Uchima Hugo, Küttner-Magalhães Ricardo, Fernandes Carlos, Morais Rui, Gupta Sunil, Martinho-Dias Daniel, Faria-Ramos Isabel, Marques Margarida, Bourke Michael J, Macedo Guilherme
Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal.
Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), 4200-135 Porto, Portugal.
J Clin Med. 2023 Aug 17;12(16):5356. doi: 10.3390/jcm12165356.
Endoscopic submucosal dissection (ESD) in colorectal lesions is demanding, and a significant rate of non-curative procedures is expected. We aimed to assess the rate of residual lesion after a piecemeal ESD resection, or after an en bloc resection but with positive horizontal margins (local-risk resection-LocRR), for colorectal benign neoplasia. A retrospective multicenter analysis of consecutive colorectal ESDs was performed. Patients with LocRR ESDs for the treatment of benign colorectal lesions with at least one follow-up endoscopy were included. A cohort of en bloc resected lesions, with negative margins, was used as the control. A total of 2255 colorectal ESDs were reviewed; 352 of the ESDs were "non-curative". Among them, 209 were LocRR: 133 high-grade dysplasia and 76 low-grade dysplasia. Ten cases were excluded due to missing data. A total of 146 consecutive curative resections were retrieved for comparison. Compared to the "curative group", LocRRs were observed in lengthier procedures, with larger lesions, and in non-granular LSTs. Recurrence was higher in the LocRR group (16/199, 8% vs. 1/146, 0.7%; = 0.002). However, statistical significance was lost when considering only en bloc resections with positive horizontal margins ( = 0.068). In conclusion, a higher rate of residual lesion was found after a piecemeal ESD resection, but not after an en bloc resection with positive horizontal margins.
内镜下黏膜剥离术（ESD）用于治疗结直肠病变具有挑战性，预计非根治性手术的比例会很高。我们旨在评估对于结直肠良性肿瘤，采用分片ESD切除术后，或整块切除但水平切缘阳性（局部风险切除-LocRR）后的残留病变率。我们对连续性结直肠ESD进行了一项回顾性多中心分析。纳入了因治疗结直肠良性病变而接受LocRR ESD且至少接受过一次随访内镜检查的患者。一组切缘阴性的整块切除病变作为对照。共回顾了2255例结直肠ESD；其中352例ESD为“非根治性”。其中，209例为LocRR：133例高级别异型增生和76例低级别异型增生。因数据缺失排除10例。共检索到146例连续性根治性切除术用于比较。与“根治性组”相比，LocRR组手术时间更长，病变更大，且发生于非颗粒状的侧向发育型肿瘤（LST）。LocRR组的复发率更高（16/199，8% vs. 1/146，0.7%；P = 0.002）。然而，仅考虑水平切缘阳性的整块切除时，统计学意义消失（P = 0.068）。总之，分片ESD切除术后残留病变率较高，但水平切缘阳性的整块切除术后并非如此。
