内镜黏膜切除术后预防复发的边缘热消融：一项系统评价和荟萃分析。
Thermal ablation of margins for recurrence prevention after endoscopic mucosal resection: a systematic review and meta-analysis.
作者信息
Santo Paula, Meine Gilmara Coelho, Holanda Erica Uchoa, Barbosa Eduardo Cerchi, Baraldo Stefano, Nau Angelica Luciana, Henry Moore Karollyna Maria
机构信息
University Hospital of Federal University of São Carlos, 111, Luís Vaz de Camões street-Vila Celina, Sao Carlos, Sao Paulo, 13566-448, Brazil.
Feevale University, Novo Hamburgo, Rio Grande do Sul, Brazil.
出版信息
Surg Endosc. 2025 Feb;39(2):741-748. doi: 10.1007/s00464-024-11498-z. Epub 2025 Jan 6.
BACKGROUND AND AIMS
Endoscopic mucosal resection (EMR) of large colorectal lesions can be challenging, and residual lesions after EMR can progress to colorectal cancer. We aimed to assess the efficacy and safety of adding thermal ablation of margins [using argon plasma coagulation (APC) or snare tip soft coagulation (STSC)] in reducing recurrence rates after EMR.
METHODS
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) identified from PubMed, Cochrane Library, and Embase. The primary outcome was the recurrence rate. Secondary outcomes were overall adverse events (AEs) and delayed bleeding. We pre-specified subgroup analyses by lesion size, thermal ablation technique, and resection type. The random-effects model was used to calculate the pooled risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using the Cochran's Q test and I statistics.
RESULTS
We included four RCTs (815 patients and 872 colorectal lesions). Thermal ablation reduced recurrence rates [RR 0.31; 95%CI (0.20-0.47); I = 0%], while the risk of overall AEs [RR 0.93; 95%CI (0.73-1.17); I = 0%] was similar between both groups. The results were consistent in subgroup analyses of APC, STSC, polyps > 20 mm, and piece-meal resection.
CONCLUSION
Thermal ablation of margins following EMR reduced recurrence rates while maintaining a comparable safety profile.
背景与目的
大肠大病变的内镜黏膜切除术（EMR）具有挑战性，EMR术后残留病变可能进展为结直肠癌。我们旨在评估在EMR术后加用边缘热消融术（使用氩等离子体凝固术（APC）或圈套器尖端软凝术（STSC））降低复发率的有效性和安全性。
方法
我们对从PubMed、Cochrane图书馆和Embase中检索到的随机对照试验（RCT）进行了系统评价和荟萃分析。主要结局是复发率。次要结局是总体不良事件（AE）和迟发性出血。我们预先设定了按病变大小、热消融技术和切除类型进行的亚组分析。采用随机效应模型计算合并风险比（RR）及95%置信区间（CI）。使用Cochran's Q检验和I统计量评估异质性。
结果
我们纳入了4项RCT（815例患者和872个大肠病变）。热消融降低了复发率[RR 0.31；95%CI（0.20 - 0.47）；I = 0%]，而两组总体AE的风险[RR 0.93；95%CI（0.73 - 1.17）；I = 0%]相似。在APC、STSC、息肉>20 mm及分片切除的亚组分析中结果一致。
结论
EMR术后边缘热消融可降低复发率，同时保持相当的安全性。
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