Cao Zhixin, Zhao Jingfang, Liu Juan, Tian Xiangguo, Shi Yongjun, Zhang Junyong, Hu Jinhua, Liu Fuli
Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P. R. China.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P. R. China.
J Cancer Res Ther. 2024 Dec 1;20(7):2055-2060. doi: 10.4103/jcrt.jcrt_515_24. Epub 2025 Jan 10.
Endoscopic submucosal dissection (ESD) is a standardized procedure for intramucosal and slightly invasive submucosal colorectal cancers (CRC). However, the role of ESD for T1b (depth of submucosal invasion: ≥1,000 μm) CRC remains unclear. This study aimed to investigate the long-term efficacy and safety of ESD for T1b CRC.
This study involved 50 patients with T1b CRC who underwent ESD, including 31 who received subsequent surgery (ESD + surgery group) and 19 who reported comorbidities or refused subsequent surgery (ESD-alone group). The clinical outcomes, lymph node metastasis (LNM) rate, and recurrence and survival rates were determined.
All the patients achieved en-bloc resection, and 41 patients achieved R0 resection. The mean tumor diameter was 31.2 ± 11.9 mm. LNM was detected in 3 (6%) cases, demonstrating high-grade tumor budding (Bd 2/3) and invasion depth of >1,500 um. LNM was significantly correlated with tumor budding (P = 0.030). The overall median follow-up period was 41.00 ± 27.69 months and 33.16 ± 19.05 months in the ESD-alone and ESD + surgery groups, respectively (P = 0.241). Two patients in the ESD group had local recurrence and two patients died. Patients in the ESD + surgery group reported no local recurrence, distant metastasis, or disease-related death. Recurrence (P = 0.074) and survival rates (P = 0.072) were not significantly different between the two groups.
The LNM rate was exceedingly low in patients with T1b. ESD is an effective and safe method for these patients. The necessity of additional surgical treatment after ESD should be comprehensively determined following the patient's characteristics.
内镜黏膜下剥离术（ESD）是用于治疗黏膜内和轻度浸润性黏膜下结直肠癌（CRC）的标准化手术。然而，ESD对于T1b期（黏膜下浸润深度：≥1000μm）CRC的作用仍不明确。本研究旨在探讨ESD治疗T1b期CRC的长期疗效和安全性。
本研究纳入了50例行ESD的T1b期CRC患者，其中31例接受了后续手术（ESD+手术组），19例因合并症或拒绝后续手术（单纯ESD组）。确定了临床结局、淋巴结转移（LNM）率以及复发和生存率。
所有患者均实现整块切除，41例患者实现R₀切除。平均肿瘤直径为31.2±11.9mm。3例（6%）病例检测到LNM，表现为高级别肿瘤芽生（Bd 2/3）且浸润深度>1500μm。LNM与肿瘤芽生显著相关（P=0.030）。单纯ESD组和ESD+手术组的总体中位随访期分别为41.00±27.69个月和33.16±19.05个月（P=0.241）。ESD组有2例患者局部复发，2例患者死亡。ESD+手术组患者未报告局部复发、远处转移或疾病相关死亡。两组之间的复发率（P=0.074）和生存率（P=0.072）无显著差异。
T1b期患者的LNM率极低。ESD对这些患者是一种有效且安全的方法。ESD术后是否需要额外的手术治疗应根据患者的特征综合确定。
