Fábián Anna, Bor Renáta, Vasas Béla, Szűcs Mónika, Tóth Tibor, Bősze Zsófia, Szántó Kata Judit, Bacsur Péter, Bálint Anita, Farkas Bernadett, Farkas Klaudia, Milassin Ágnes, Rutka Mariann, Resál Tamás, Molnár Tamás, Szepes Zoltán
Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary.
Department of Pathology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary.
World J Gastrointest Endosc. 2024 Apr 16;16(4):193-205. doi: 10.4253/wjge.v16.i4.193.
Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging, and evidence regarding a surveillance-only strategy is limited.
To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.
A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020. Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were investigated. Event rates for categorical variables and means for continuous variables with 95% confidence intervals were calculated, and Fisher's exact test and Mann-Whitney test were performed. Potential risk factors of adverse outcomes were determined with univariate and multivariate logistic regression models.
In total, 135 lesions (mean size: 22.1 mm; location: 42% rectal) from 129 patients (mean age: 67.7 years; 56% male) were enrolled. The proportion of pedunculated and non-pedunculated lesions was similar, with en bloc resection in 82% and 47% of lesions, respectively. Tumor differentiation, distance from resection margins, depth of submucosal invasion, lymphovascular invasion, and budding were reported at 89.6%, 45.2%, 58.5%, 31.9%, and 25.2%, respectively. Residual tumor was found in 10 patients, and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection. Univariate analysis identified piecemeal resection as a risk factor for residual malignancy (odds ratio: 1.74; = 0.042). At least 1 year of follow-up was available for 117 lesions from 111 patients (mean follow-up period: 5.59 years). Overall, 54%, 30%, 30%, 11%, and 16% of patients presented at the 1-year, 3-year, 5-year, 7-year, and 9-10-year surveillance examinations. Adverse outcomes occurred in 9.0% (local recurrence and dissemination in 4 patients and 9 patients, respectively), with no difference between patients undergoing secondary surgery and surveillance only.
Reporting of histological features and adherence to surveillance colonoscopy needs improvement. Long-term adverse outcome rates might be higher than previously reported, irrespective of whether secondary surgery was performed.
选择恶性大肠息肉的最佳息肉切除术后管理策略具有挑战性，关于仅进行监测策略的证据有限。
评估内镜切除恶性大肠息肉后的长期结局。
进行一项单中心回顾性队列研究，以评估2010年至2020年间内镜切除恶性大肠息肉后的结局。调查二次手术后的残留疾病率和淋巴结转移情况，以及随访至少1年的患者的局部和远处复发率。计算分类变量的事件发生率和连续变量的均值及其95%置信区间，并进行Fisher精确检验和Mann-Whitney检验。采用单因素和多因素逻辑回归模型确定不良结局的潜在危险因素。
共纳入129例患者的135个病变（平均大小：22.1 mm；部位：42%位于直肠）（平均年龄：67.7岁；56%为男性）。有蒂和无蒂病变的比例相似，分别有82%和47%的病变整块切除。肿瘤分化、切缘距离、黏膜下浸润深度、淋巴管浸润和芽生的报告率分别为89.6%、45.2%、58.5%、31.9%和25.2%。10例患者发现残留肿瘤，41例接受二次手术切除的患者中有4例发现淋巴结转移。单因素分析确定分块切除是残留恶性肿瘤的危险因素（比值比：1.74；P = 0.042）。111例患者的117个病变有至少1年的随访资料（平均随访期：5.59年）。总体而言，54%、30%、30%、11%和16%的患者在1年、3年、5年、7年和9 - 10年的监测检查时出现。9.0%的患者出现不良结局（分别有4例和9例患者出现局部复发和播散），接受二次手术和仅接受监测的患者之间无差异。
组织学特征的报告和结肠镜监测的依从性需要改进。无论是否进行二次手术，长期不良结局发生率可能高于先前报道。
