Kafka N J, Coller J A
Department of Colon and Rectal Surgery, Lahey Hitchcock Medical Center, Burlington, Massachusetts, USA.
Surg Oncol Clin N Am. 1996 Jul;5(3):633-61.
Malignant polyps are adenomatous polyps that contain cancerous cells that have penetrated the muscularis mucosae. Pedunculated malignant polyps that have not yet developed to level 4 invasion and have no other adverse histopathologic criteria have a high likelihood of cure by endoscopic excision alone. However, if level 4 invasion has been reached or if any additional adverse characteristic, such as poor differentiation, lymphatic or venous invasion, or close or involved margins, is present, the risk of inadequate treatment from endoscopic excision alone becomes appreciable. Under such circumstances, a definitive resection is favored unless the increased risk of recurrence is offset by age-related limited life expectancy or substantial comorbidities. Sessile malignant polyps are more likely to demonstrate level 4 invasion. In addition, these lesions are often less satisfactorily treated by endoscopic excision. In most circumstances, unless patient factors contraindicate intervention, resection should be performed.
恶性息肉是指腺瘤性息肉中含有已穿透黏膜肌层的癌细胞。尚未发展到4级浸润且无其他不良组织病理学标准的带蒂恶性息肉，仅通过内镜切除就有很高的治愈可能性。然而，如果已达到4级浸润，或者存在任何其他不良特征，如分化差、淋巴管或血管浸润，或切缘接近或受累，仅通过内镜切除治疗不充分的风险就会变得明显。在这种情况下，除非与年龄相关的有限预期寿命或严重合并症抵消了复发风险增加，否则倾向于进行根治性切除。无蒂恶性息肉更有可能表现为4级浸润。此外，这些病变通常通过内镜切除治疗效果较差。在大多数情况下，除非患者因素禁忌干预，否则应进行切除。
