Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Surg Endosc. 2024 Apr;38(4):2267-2272. doi: 10.1007/s00464-024-10726-w. Epub 2024 Mar 4.
Appendiceal orifice lesions are often managed operatively with limited or oncologic resections. The aim is to report the management of appendiceal orifice mucosal neoplasms using advanced endoscopic interventions.
Patients with appendiceal orifice mucosal neoplasms who underwent advanced endoscopic resections between 2011 and 2021 with either endoscopic mucosal resection (EMR), endoscopic mucosal dissection (ESD), hybrid ESD, or combined endoscopic laparoscopic surgery (CELS) were included from a prospectively collected dataset. Patient and lesion details and procedure outcomes are reported.
Out of 1005 lesions resected with advanced endoscopic techniques, 41 patients (4%) underwent appendiceal orifice mucosal neoplasm resection, including 39% by hybrid ESD, 34% by ESD, 15% by EMR, and 12% by CELS. The median age was 65, and 54% were male. The median lesion size was 20 mm. The dissection was completed piecemeal in 49% of patients. Post-procedure, one patient had a complication within 30 days and was admitted with post-polypectomy abdominal pain treated with observation for 2 days with no intervention. Pathology revealed 49% sessile-serrated lesions, 24% tubular adenomas, and 15% tubulovillous adenomas. Patients were followed up for a median of 8 (0-48) months. One patient with a sessile-serrated lesion experienced a recurrence after EMR which was re-resected with EMR.
Advanced endoscopic interventions for appendiceal orifice mucosal neoplasms can be performed with a low rate of complications and early recurrence. While conventionally lesions at the appendiceal orifice are often treated with surgical resection, advanced endoscopic interventions are an alternative approach with promising results which allow for cecal preservation.
阑尾口病变通常采用有限或肿瘤切除术进行手术治疗。本研究旨在报告使用先进的内镜介入治疗阑尾口黏膜肿瘤的处理方法。
从前瞻性收集的数据集中纳入了 2011 年至 2021 年间接受先进内镜切除术（包括内镜黏膜切除术[EMR]、内镜黏膜下剥离术[ESD]、混合 ESD 或联合内镜腹腔镜手术[CELS]）治疗的阑尾口黏膜肿瘤患者。报告患者和病变详细信息及手术结果。
在 1005 例采用先进内镜技术切除的病变中，有 41 例（4%）患者行阑尾口黏膜肿瘤切除术，其中 39%采用混合 ESD、34%采用 ESD、15%采用 EMR、12%采用 CELS。中位年龄为 65 岁，54%为男性。中位病变大小为 20mm。49%的患者分次整块切除。术后 1 例患者在 30 天内出现并发症，因经内镜切除息肉后腹痛而住院，给予观察 2 天，未进行干预。病理结果显示 49%为无蒂锯齿状病变、24%为管状腺瘤、15%为管状绒毛状腺瘤。患者中位随访时间为 8（0-48）个月。1 例无蒂锯齿状病变患者在接受 EMR 治疗后复发，再次接受 EMR 切除。
对于阑尾口黏膜肿瘤，先进的内镜介入治疗可实现低并发症率和早期复发率。传统上，阑尾口的病变通常采用手术切除治疗，而先进的内镜介入治疗是一种替代方法，具有令人鼓舞的结果，可保留盲肠。
