Gauci Julia L, Whitfield Anthony, Medas Renato, Kerrison Clarence, Mandarino Francesco Vito, Gibson David, O'Sullivan Timothy, Cronin Oliver, Gupta Sunil, Lam Brian, Perananthan Varan, Hourigan Luke, Zanati Simon, Singh Rajvinder, Raftopoulos Spiro, Moss Alan, Brown Gregor, Klein Amir, Desomer Lobke, Tate David J, Williams Steven J, Lee Eric Y, Burgess Nicholas, Bourke Michael J
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School of Medicine, University of Sydney, Sydney, Australia.
Clin Gastroenterol Hepatol. 2025 Mar;23(4):555-563.e1. doi: 10.1016/j.cgh.2024.07.017. Epub 2024 Jul 31.
Endoscopic submucosal dissection is increasingly promoted for the treatment of all large nonpedunculated colorectal polyps (LNPCPs) to cure potential low-risk cancers (superficial submucosal invasion without additional high-risk histopathologic features). The effect of a universal en bloc strategy on oncologic outcomes for the treatment of LNPCPs in the right colon is unknown. We evaluated this in a large Western population.
A prospective cohort of patients referred for endoscopic resection (ER) of LNPCPs was analyzed. Patients found to have cancer after ER and those referred directly to surgery were included. The primary outcome was to determine the proportion of right colon LNPCPs with low-risk cancer.
Over 180 months until June 2023, 3294 sporadic right colon LNPCPs in 2956 patients were referred for ER at 7 sites (median size 30 [interquartile range 22.5-37.5] mm). A total of 63 (2.1%) patients were referred directly to surgery, and cancer was proven in 56 (88.9%). A total of 2851 (96.4%) of 2956 LNPCPs underwent ER (median size 35 [interquartile range 25-45] mm), of which 75 (2.6%) were cancers. The overall prevalence of cancer in the right colon was 4.4% (n = 131 of 2956). Detailed histopathologic analysis was possible in 115 (88%) of 131 cancers (71 after ER, 44 direct to surgery). After excluding missing histopathologic data, 23 (0.78%) of 2940 sporadic right colon LNPCPs were low-risk cancers.
The proportion of right colon LNPCPs referred for ER containing low-risk cancer amenable to endoscopic cure was <1%, in a large, multicenter Western cohort. A universal endoscopic submucosal dissection strategy for the management of right colon LNPCPs is unlikely to yield improved patient outcomes given the minimal impact on oncologic outcomes.
gov, Numbers: NCT01368289, NCT02000141.
内镜黏膜下剥离术越来越多地被推广用于治疗所有大型无蒂结直肠息肉（LNPCP），以治愈潜在的低风险癌症（黏膜下浅层浸润且无其他高风险组织病理学特征）。通用整块切除策略对右半结肠LNPCP治疗的肿瘤学结局的影响尚不清楚。我们在一大群西方人群中对此进行了评估。
分析了一组因LNPCP接受内镜切除（ER）的前瞻性队列患者。纳入ER后发现患有癌症的患者以及直接转诊至手术的患者。主要结局是确定右半结肠LNPCP中低风险癌症的比例。
截至2023年6月的180多个月里，2956例患者中的3294个散发性右半结肠LNPCP在7个地点接受了ER（中位大小30 [四分位间距22.5 - 37.5] mm）。共有63例（2.1%）患者直接转诊至手术，其中56例（88.9%）被证实患有癌症。2956个LNPCP中的2851个（96.4%）接受了ER（中位大小35 [四分位间距25 - 45] mm），其中75个（2.6%）为癌症。右半结肠癌症的总体患病率为4.4%（2956例中的131例）。131例癌症中的115例（88%）进行了详细的组织病理学分析（ER后71例，直接手术44例）。排除缺失的组织病理学数据后，2940个散发性右半结肠LNPCP中有23个（0.78%）为低风险癌症。
在一个大型多中心西方队列中，接受ER的右半结肠LNPCP中可通过内镜治愈的低风险癌症比例<1%。鉴于对肿瘤学结局影响极小，通用的内镜黏膜下剥离术策略用于管理右半结肠LNPCP不太可能改善患者结局。
gov，编号：NCT01368289，NCT02000141。
