Takehara Yudai, Yamashita Ken, Morimoto Shin, Tanino Fumiaki, Yamamoto Noriko, Kamigaichi Yuki, Tanaka Hidenori, Takigawa Hidehiko, Urabe Yuji, Kuwai Toshio, Arihiro Koji, Oka Shiro
Department of Gastroenterology Hiroshima University Hospital Hiroshima Japan.
Gastrointestinal Endoscopy and Medicine Hiroshima University Hospital Hiroshima Japan.
DEN Open. 2024 Oct 24;5(1):e70030. doi: 10.1002/deo2.70030. eCollection 2025 Apr.
To evaluate endoscopic resection strategies for cT1b colorectal carcinomas (CRCs) ≤20 mm to determine strategies that enable adequate vertical margins (VMs).
We enrolled 128 consecutive patients with cT1b colorectal carcinomas ≤20 mm resected by endoscopic mucosal resection or hybrid endoscopic submucosal dissection (ESD). Tumor lifting conditions after submucosal injection were classified into type A (lifting, soft dome-like), type B (lifting, hard trapezoid-like), and non-lifting (positive non-lifting sign). Predictors of positive VMs (VM 1) and adequate VMs were identified.
All non-lifting tumors were resected by hybrid ESD and VMs were ≥500 µm. Vertical margin 1 tumors were only found in the endoscopic mucosal resection group, in which, the proportion of type B tumors with VM 1 was significantly higher than that of tumors with negative VMs ( < 0.01). Type A tumors showed no significant between-group differences. Among type B tumors, the proportion of VMs ≥500 µm was significantly higher ( < 0.01) and the VM distance was significantly longer ( < 0.01) in the hybrid ESD group than in the endoscopic mucosal resection group.
Hybrid ESD can be selected for type B tumors to ensure adequate VMs.
评估cT1b期直径≤20 mm的结直肠癌（CRC）的内镜切除策略，以确定能获得足够垂直切缘（VM）的策略。
我们纳入了128例连续的cT1b期直径≤20 mm的结直肠癌患者，这些患者接受了内镜黏膜切除术或内镜黏膜下剥离术（ESD）联合内镜下切除。黏膜下注射后的肿瘤抬举情况分为A 型（抬举，软圆顶状）、B型（抬举，硬梯形）和未抬举（阳性未抬举征）。确定了阳性VM（VM 1）和足够VM的预测因素。
所有未抬举的肿瘤均通过ESD联合内镜下切除，VM≥500 µm。VM 1肿瘤仅在内镜黏膜切除组中发现，其中，VM 1的B型肿瘤比例显著高于VM阴性的肿瘤（<0.01）。A型肿瘤组间无显著差异。在B型肿瘤中，ESD联合内镜下切除组VM≥500 µm的比例显著更高（<0.01），VM距离显著更长（<0.01）。
对于B型肿瘤可选择ESD联合内镜下切除以确保足够的VM。
