对来自非结直肠癌流行地区的复杂侧向扩散型结直肠肿瘤进行内镜下黏膜下剥离术的临床审计。

Clinical audit of endoscopic sub-mucosal dissection performed for complex lateral spreading colorectal tumors from a region non-endemic for colorectal cancer.

作者信息

Ansari Jaseem, Bapaye Harsh, Shah Jimil, Raina Hameed, Gandhi Ashish, Bapaye Jay, B R Ajay, Pagadapelli Arun Arora, Bapaye Amol

机构信息

Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, 411 004, India.

Department of Internal Medicine, Byramjee Jeejeebhoy Medical College, Pune, 411 001, India.

出版信息

Indian J Gastroenterol. 2024 Oct;43(5):1002-1011. doi: 10.1007/s12664-024-01631-0. Epub 2024 Aug 5.

DOI:10.1007/s12664-024-01631-0

PMID:39102130

Abstract

BACKGROUND

Endoscopic resection is currently the treatment of choice for laterally spreading tumors (LSTs). Endoscopic sub-mucosal dissection (ESD) can achieve higher enbloc resection and R0 resection, albeit at a slightly higher risk of complications. Given scarce data on ESD from India, we performed a retrospective analysis of our experience with colorectal ESD (CR-ESD) to know its clinical efficacy and complications as well as to assess the learning curve of CR-ESD in non-endemic-areas.

METHODS

Retrospective analysis of prospectively maintained datasheet performed. All patients with large (>2cm), complex or recurrent colorectal LST who underwent ESD at our center between 2012 and 2021 were included in the study. Various baseline lesion-related parameters, procedure-related parameters, enbloc resection (ER) rates, R0 margins and adverse event rates were retrieved. CUSUM analysis was performed to calculate the minimum required procedures to achieve competency in CR-ESD.

RESULTS

Total 149 patients were included in the study; mean patient age was 61.36±18.21 years. Most patients had lesions in rectum (n=102; 68.5%) followed by sigmoid colon (n=25; 16.8%). The mean lesion size was 46.62 ± 25.46 mm and the mean procedure duration for ESD was 219.30 ± 150.05 min. ER was achieved in 94.6% of lesions. R0 resection was achieved in 132 patients (88.6%). Overall, six (4%) adverse events were noted, of which one required surgical intervention. As many as 105 patients (70.5%) had adenomatous lesions on histology. Seventy-four patients underwent follow-up colonoscopy, of which three had a recurrence of adenomatous lesions and five had post-resection stricture requiring endoscopic dilation. CUSUM curve analysis calculated the learning curve for ESD was 47 resections for ER and 55 for the occurrence of AEs, with a composite CUSUM at 47 procedures.

CONCLUSION

CR-ESD even in non-endemic area is associated with high en bloc resection rates, R0 resection rates and acceptable complication profile. Approximately 50 cases of CR-ESD are required to achieve competency.

摘要

背景

内镜切除术目前是侧向扩散肿瘤（LSTs）的首选治疗方法。内镜粘膜下剥离术（ESD）能够实现更高的整块切除率和R0切除率，尽管并发症风险略高。鉴于印度关于ESD的数据稀缺，我们对我们的大肠ESD（CR-ESD）经验进行了回顾性分析，以了解其临床疗效和并发症，并评估非流行地区CR-ESD的学习曲线。

方法

对前瞻性维护的数据表进行回顾性分析。纳入2012年至2021年间在我们中心接受ESD治疗的所有大的（>2cm）、复杂或复发性大肠LST患者。检索各种基线病变相关参数、手术相关参数、整块切除（ER）率、R0切缘和不良事件发生率。进行累积和（CUSUM）分析以计算在CR-ESD中达到熟练程度所需的最少手术例数。

结果

本研究共纳入149例患者；患者平均年龄为61.36±18.21岁。大多数患者的病变位于直肠（n=102；68.5%），其次是乙状结肠（n=25；16.8%）。平均病变大小为46.62±25.46mm，ESD的平均手术时间为219.30±150.05分钟。94.6%的病变实现了整块切除。132例患者（88.6%）实现了R0切除。总体而言，记录到6例（4%）不良事件，其中1例需要手术干预。多达105例患者（70.5%）组织学检查显示为腺瘤性病变。74例患者接受了随访结肠镜检查，其中3例腺瘤性病变复发，5例切除后狭窄需要内镜扩张。CUSUM曲线分析计算出ESD的学习曲线为整块切除47例，不良事件发生55例，累积和综合为47例手术。