Ulkucu Attila, Erkaya Metincan, Erozkan Kamil, Catalano Brogan, Liska David, Allende Daniela, Steele Scott R, Sommovilla Joshua, Gorgun Emre
Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH. Electronic address: https://twitter.com/AttilaUlkucu.
Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH. Electronic address: https://twitter.com/MetinErkayaMD.
Surgery. 2025 Mar;179:109030. doi: 10.1016/j.surg.2024.109030. Epub 2024 Dec 27.
Endoscopic submucosal dissection is increasingly used to treat early-stage colorectal cancer. This study evaluated the feasibility of endoscopic submucosal dissection in this setting and the determinants of lymph node metastasis.
We reviewed patients who underwent colorectal endoscopic submucosal dissection for early-stage colorectal cancer at a tertiary center between 2011 and 2023. The primary outcome was the identification of high-risk pathologic features predictive of lymph node metastasis in patients undergoing oncologic colon resection following endoscopic submucosal dissection.
We reviewed 1,398 patients who underwent endoscopic submucosal dissection, and 83 (6%) had colorectal cancer. Twenty-four patients (29%) were closely monitored after endoscopic submucosal dissection, and 59 (71%) underwent oncologic colon resection because of high-risk pathologies of the endoscopic submucosal dissection specimen. In the oncologic colon resection group, the mean age was 62.7 years (±10.2), with 56% male predominance, and 14% showed positive lymph nodes in the final pathology. Analysis comparing patients with and without lymph node metastasis showed significant differences in sex, lesion size, submucosal invasion depth, and budding scores. Multivariate analysis showed that lesions with a submucosal invasion depth ≥2.00 mm of the endoscopic submucosal dissection resection specimen had higher odds of lymph node metastasis (odds ratio 18.7, P = .028), whereas lesions with a diameter >20 mm were associated with a lower likelihood of lymph node metastasis (odds ratio 0.07, P = .036).
The study highlights the oncologic safety of early-stage endoscopic submucosal dissection as a viable treatment option for carefully selected patients with colorectal cancer. After tissue resection with endoscopic submucosal dissection, if the lesion size is less than 20 mm, depth of invasion up to 2 mm may be considered safe in the absence of other high-risk pathologic factors.
内镜黏膜下剥离术越来越多地用于治疗早期结直肠癌。本研究评估了内镜黏膜下剥离术在这种情况下的可行性以及淋巴结转移的决定因素。
我们回顾了2011年至2023年在一家三级中心接受早期结直肠癌结直肠内镜黏膜下剥离术的患者。主要结局是在内镜黏膜下剥离术后接受肿瘤性结肠切除术的患者中识别预测淋巴结转移的高危病理特征。
我们回顾了1398例行内镜黏膜下剥离术的患者，其中83例（6%）患有结直肠癌。24例（29%）在内镜黏膜下剥离术后接受密切监测，59例（71%）因内镜黏膜下剥离术标本存在高危病理情况而接受肿瘤性结肠切除术。在肿瘤性结肠切除术组中，平均年龄为62.7岁（±10.2），男性占56%，最终病理显示14%有阳性淋巴结。对有和无淋巴结转移患者的分析显示，在性别、病变大小、黏膜下浸润深度和芽生评分方面存在显著差异。多因素分析显示，内镜黏膜下剥离术切除标本的黏膜下浸润深度≥2.00 mm的病变发生淋巴结转移的几率更高（比值比18.7，P = 0.028），而直径>20 mm的病变发生淋巴结转移的可能性较低（比值比0.07，P = 0.036）。
该研究强调了早期内镜黏膜下剥离术对于精心挑选的结直肠癌患者作为一种可行治疗选择的肿瘤学安全性。在内镜黏膜下剥离术进行组织切除后，如果病变大小小于20 mm，在没有其他高危病理因素的情况下，浸润深度达2 mm可能被认为是安全的。
