Hackelsberger A, Frühmorgen P, Weiler H, Heller T, Seeliger H, Junghanns K
Department of Medicine I, Klinikum Ludwigsburg, Germany.
Endoscopy. 1995 Feb;27(2):153-8. doi: 10.1055/s-2007-1005654.
Invasive carcinoma is found at histology in 2-5% of colorectal polyps removed under flexible endoscopy. The aim of this study was to confirm that histologically complete endoscopic polypectomy under favorable low-risk conditions is sufficient therapy for pT1 carcinoma, while tumors at or close to the margin of the polypectomy, and histological high-risk criteria, require surgical resection with lymphadenectomy.
Eighty-six patients with 87 pT1 carcinomas underwent polypectomy within a twelve-and-a-half-year period. Further treatment prospectively followed the above guidelines. The follow-up was documented.
A local tumor residue was found in 5 of 34 patients who had undergone surgical resection for doubtful or incomplete polypectomy. Two patients were found to have nodal disease in the surgical specimen, only one of them harboring a high-risk carcinoma. Two further patients with high-risk carcinomas had tumor progression, despite postpolypectomy resections without local tumor residue or lymph-node infiltration, and died. One patient had a local tumor recurrence on follow-up endoscopy eight weeks after doubtfully complete polypectomy. He underwent resection, and had no further recurrence. No further manifestations of invasive carcinoma occurred after complete polypectomy of 42 patients with low-risk carcinomas.
This study supports the view that complete endoscopic polypectomy is an adequate therapy for low-risk carcinoma: A modification of the follow-up regimen, with less frequent endoscopic controls, is justified.
在经软性内镜切除的大肠息肉中，组织学检查发现2%-5%存在浸润性癌。本研究的目的是证实，在有利的低风险条件下进行组织学上完整的内镜息肉切除术是pT1期癌的充分治疗方法，而息肉切除术边缘处或接近边缘处的肿瘤以及组织学高风险标准则需要行手术切除并清扫淋巴结。
在12.5年的时间里，86例患有87个pT1期癌的患者接受了息肉切除术。进一步的治疗前瞻性地遵循上述指南，并记录随访情况。
在34例因息肉切除可疑或不完整而接受手术切除的患者中，有5例发现局部肿瘤残留。手术标本中发现2例有淋巴结转移，其中只有1例为高风险癌。另外2例高风险癌患者尽管在息肉切除术后进行了切除，且无局部肿瘤残留或淋巴结浸润，但仍发生肿瘤进展并死亡。1例患者在可疑完全性息肉切除术后8周的随访内镜检查中出现局部肿瘤复发。他接受了切除手术，未再复发。42例低风险癌患者在完全性息肉切除术后未再出现浸润性癌的其他表现。
本研究支持以下观点，即完整的内镜息肉切除术是低风险癌的充分治疗方法：调整随访方案，减少内镜检查频率是合理的。
