Kawashima Kazumasa, Hikichi Takuto, Onizawa Michio, Gunji Naohiko, Watahiki Yu, Sakuma Chiharu, Mochimaru Tomoaki, Murakami Mai, Suzuki Osamu, Hashimoto Yuko, Kobayakawa Masao, Ohira Hiromasa
Department of Gastroenterology Fukushima Medical University Fukushima Japan.
Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan.
DEN Open. 2023 Oct 12;4(1):e300. doi: 10.1002/deo2.300. eCollection 2024 Apr.
Endoscopic submucosal dissection (ESD) enables en bloc resection of colorectal neoplasms, but occasionally results in positive horizontal margins (HMs). However, the site of the resected specimen that tends to be positive for HM has not been investigated. We aimed to clarify the characteristics associated with HMs in lesions resected en bloc with ESD.
Patients with colorectal neoplasms who underwent en bloc resection with ESD were included in this study. The patients were divided into negative HMs (HM0) and positive or indeterminate HMs (HM1) groups. The characteristics associated with HM1 resection were investigated. In addition, the local recurrence rate during endoscopic follow-up for >6 months after ESD was observed.
In total, 201 lesions were analyzed in 189 patients (HM0, 189 lesions; HM1, 12 lesions). The HM1 group had a significantly larger median lesion diameter (25 vs. 55 mm; < 0.001) and more lesions with >50% circumference than did the HM0 group ( < 0.001). Furthermore, the prevalence of severe fibrosis was significantly higher in the HM1 group than in the HM0 group ( < 0.001). Positive horizontal sites of the resected specimens were more frequent at the oral and anal sites than at the lateral sites. No local recurrences were observed in either group.
The characteristics associated with HM1 depended on lesion size, particularly lesions with >50% circumference, and submucosal fibrosis.
内镜黏膜下剥离术（ESD）能够完整切除结直肠肿瘤，但偶尔会出现水平切缘（HM）阳性的情况。然而，尚未对切除标本中易于出现HM阳性的部位进行研究。我们旨在阐明ESD完整切除病变中与HM相关的特征。
本研究纳入了接受ESD完整切除的结直肠肿瘤患者。将患者分为HM阴性（HM0）组和HM阳性或不确定（HM1）组。研究与HM1切除相关的特征。此外，观察ESD后内镜随访超过6个月期间的局部复发率。
总共分析了189例患者的201个病变（HM0，189个病变；HM1，12个病变）。与HM0组相比，HM1组的病变中位直径显著更大（25对55毫米；<0.001），且周长>50%的病变更多（<0.001）。此外，HM1组严重纤维化的患病率显著高于HM0组（<0.001）。切除标本的HM阳性部位在口侧和肛侧比在外侧更常见。两组均未观察到局部复发。
与HM1相关的特征取决于病变大小，尤其是周长>50%的病变以及黏膜下纤维化。
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