Radosavljevic Ivana, Dam Aamir, Luthra Anjuli K, Pena Luis, Cappelle Saraswathi, Permuth Jennifer B, Felder Seth, Sanchez Julian, Stefanou Amalia, Friedman Mark, Mok Shaffer R
Department of Internal Medicine, Emory University, Atlanta, United States.
Department of Gastrointestinal Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, United States.
Endosc Int Open. 2025 Sep 1;13:a26372047. doi: 10.1055/a-2637-2047. eCollection 2025.
The current standard of care for patients who are found to have malignancy within a resected colorectal polyp segment is surgical resection. Our study aimed to illustrate the efficacy and safety of using endoscopic full thickness resection (EFTR) to achieve histologically complete (R0) resection and formal staging in malignant polypectomy scars.
This was a prospective case series of 14 patients who underwent scar consolidation via EFTR following piecemeal polypectomy or endoscopic mucosal resection (EMR) of a malignant colorectal polyp. Variables collected assessed R0 resection, technical success of the procedure, residual disease within the scar, recurrence during follow up, and adverse events (AEs).
Of the 14 patient cases reviewed, there was 100% technical success and residual malignancy (RM) found in 14%. Of the two patients with residual disease, one achieved R0 resection with EFTR whereas the other did not and subsequently underwent surgery with no histopathological evidence of malignancy in the resected tissue. There was one AE of rectal bleeding that did not require any surgical intervention or blood transfusions.
EFTR could offer endoscopists a safe, efficacious, and minimally invasive mechanism for formal tumor (T) staging of malignancies found within polypectomy segments. Further studies with larger sample sizes are needed to assess outcomes in patients with residual neoplastic disease.
对于在切除的大肠息肉段发现恶性肿瘤的患者，目前的标准治疗方法是手术切除。我们的研究旨在阐明使用内镜全层切除术（EFTR）在恶性息肉切除术后瘢痕中实现组织学完全（R0）切除和准确分期的有效性和安全性。
这是一项前瞻性病例系列研究，纳入了14例患者，这些患者在进行恶性大肠息肉的分块息肉切除术或内镜黏膜切除术（EMR）后，通过EFTR进行瘢痕巩固。收集的变量包括R0切除、手术技术成功率、瘢痕内残留疾病、随访期间的复发情况以及不良事件（AE）。
在回顾的14例患者中，手术技术成功率为100%，14%发现有残留恶性肿瘤（RM）。在两名有残留疾病的患者中，一名通过EFTR实现了R0切除，而另一名未实现，随后接受了手术，切除组织中无恶性肿瘤的组织病理学证据。有1例直肠出血不良事件，无需任何手术干预或输血。
EFTR可为内镜医师提供一种安全、有效且微创的机制，用于对息肉切除段内发现的恶性肿瘤进行准确的肿瘤（T）分期。需要进一步开展更大样本量的研究来评估有残留肿瘤疾病患者的预后。
