Tribonias George, Papaefthymiou Apostolis, Zormpas Petros, Seewald Stefan, Zachou Maria, Barbaro Federico, Kahaleh Michel, Andrisani Gianluca, Elkholy Shaimaa, El-Sherbiny Mohamed, Komeda Yoriaki, Yarlagadda Raghavendra, Tziatzios Georgios, Essam Kareem, Haggag Hany, Paspatis Gregorios, Mavrogenis Georgios
Department of Gastroenterology, Red Cross Hospital, 11526 Athens, Greece.
Digestive Diseases and Surgery Institute, Cleveland Clinic, London SW1X 7HY, UK.
J Clin Med. 2024 Nov 18;13(22):6951. doi: 10.3390/jcm13226951.
Resected rectal polyps with deep invasion into the submucosa (pT1b-sm2,3) or the muscle layer (pT2) are currently confronted with surgery due to non-curative resection. We evaluated the efficacy, safety, and locoregional control of adjuvant radiotherapy (RT) and/or chemotherapy (CT) following endoscopic KAR (knife-assisted resection) in patients with invasive early rectal cancers who are unwilling or unsuitable for additional surgical resection. Fifty-one patients with early rectal cancers, pT1b or pT2, underwent post-resection adjuvant RT and/or CT in 15 centers worldwide. "En bloc" macroscopic resection, R0 resection, recurrence rate, and adverse events following resection and adjuvant therapy were recorded in a multicenter retrospective cohort study. Diagnostic staging (38/51, 75%) was the main reason for ELE. Macroscopic "en bloc" resection was demonstrated in 50/51 (98%), with an average follow-up of 20.6 months. Endoscopic recurrence occurred in 7/51 (13.7%) of patients, with mean time for diagnosis of recurrence at 8.9 months. Adjuvant therapy consisted of RT in 49.0% (25/51), CT in 11.8% (6/51), and combined CRT in 39.2% (20/51) of the cases. Perforation, severe post-procedural bleeding, and incontinence were the most frequent complications. The absence of superficial ulceration was associated with macroscopic complete resection, while the lesions with lower budding stage, clear lateral margins, lesion size < 40 mm, and needle-type knife used were associated with less endoscopic recurrencies. Our data investigated adjuvant RT and/or CT after endoscopic KAR of infiltrative rectal cancers (pT1bsm2,3-pT2) as being safe and effective for locoregional control and providing a non-surgical treatment option for patients with a non-curative resection.
对于已切除但浸润至黏膜下层深层（pT1b-sm2,3）或肌层（pT2）的直肠息肉，由于切除不彻底，目前面临着手术难题。我们评估了内镜下KAR（刀辅助切除术）后辅助放疗（RT）和/或化疗（CT）对不愿或不适合进行额外手术切除的早期浸润性直肠癌患者的疗效、安全性和局部区域控制情况。全球15个中心的51例pT1b或pT2期早期直肠癌患者接受了切除术后辅助RT和/或CT治疗。在一项多中心回顾性队列研究中记录了“整块”宏观切除、R0切除、切除及辅助治疗后的复发率和不良事件。诊断分期（38/51，75%）是进行内镜下整块切除（ELE）的主要原因。50/51（98%）实现了宏观“整块”切除，平均随访20.6个月。7/51（13.7%）的患者发生内镜复发，复发诊断的平均时间为8.9个月。辅助治疗包括49.0%（25/51）的病例接受RT，11.8%（6/51）的病例接受CT，39.2%（20/51）的病例接受同步放化疗。穿孔、严重的术后出血和失禁是最常见的并发症。无浅表溃疡与宏观完全切除相关，而萌芽期较低、切缘清晰、病变大小<40 mm以及使用针型刀的病变与较少的内镜复发相关。我们的数据研究表明，浸润性直肠癌（pT1b-sm2,3-pT2）内镜下KAR后辅助RT和/或CT对局部区域控制安全有效，为切除不彻底的患者提供了一种非手术治疗选择。
