Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study

被引:12
作者
Santos-Antunes, Joao [1 ,2 ]
Pioche, Mathieu [3 ]
Ramos-Zabala, Felipe [4 ]
Cecinato, Paolo [5 ]
Gallego Rojo, Francisco J. [6 ]
Barreiro, Pedro [7 ,8 ]
Felix, Catarina [7 ]
Sferrazza, Sandro [9 ]
Berr, Frieder [10 ]
Wagner, Andrej [10 ]
Lemmers, Arnaud [11 ]
Ferreira, Mariana Figueiredo [11 ]
Albeniz, Eduardo [12 ]
Uchima, Hugo [13 ,14 ]
Kuttner-Magalhaes, Ricardo [15 ]
Fernandes, Carlos [16 ]
Morais, Rui [1 ]
Gupta, Sunil [17 ]
Martinho-Dias, Daniel [18 ]
Rios, Elisabete [19 ]
Faria-Ramos, Isabel [2 ]
Marques, Margarida [1 ]
Bourke, Michael J. [17 ]
Macedo, Guilherme [1 ]
机构
[1] Ctr Hosp Univ S Joao, Fac Med, Gastroenterol Dept, Porto, Portugal
[2] Univ Porto, Ipatimup I3S Inst Invest & Inovacao Saude, Porto, Portugal
[3] Hop Edouard Herriot, Dept Hepatol & Gastroenterol, Lyon, France
[4] Univ San Pablo CEU, CEU Univ Madrid, Hosp Univ HM Monteprincipe, HM Hosp,Dept Gastroenterol,Dept Clin Med Sci, Madrid, Spain
[5] Azienda USL IRCCS Reggio Emilia, Gastroenterol & Digest Endoscopy Unit, Reggio Emilia, Italy
[6] Hosp Poniente, Gastroenterol Dept, Almeria, Spain
[7] Ctr Hosp Lisboa Ocidental EPE, Gastroenterol Dept, Lisbon, Portugal
[8] Hosp Lusiadas, Lisbon Adv Endoscop Ctr, Lisbon, Portugal
[9] Santa Chiara Hosp, Gastroenterol & Endoscopy Unit, Trento, Italy
[10] Paracelsus Med Univ, Univ Clin Salzburg, Dept Internal Med 1, Salzburg, Austria
[11] Univ Libre Bruxelles ULB, CUB Erasme Hosp, Dept Gastroenterol Hepatopancreatol & Digest Onco, Brussels, Belgium
[12] Univ Publ Navarra, Complejo Hosp Navarra, Navarrabiomed Res Inst, IdiSNA, Pamplona, Spain
[13] Ctr Med Teknon, Digest Endoscopy Serv, Barcelona, Spain
[14] Hosp Badalona Germans Trias & Pujol, Gastroenterol Serv, Barcelona, Spain
[15] Ctr Hosp Univ Porto, Hosp Santo Antonio, Gastroenterol Dept, Porto, Portugal
[16] Ctr Hosp Vila Nova de Gaia Espinho, Gastroenterol Dept, Vila Nova De Gaia, Portugal
[17] Westmead Hosp, Dept Gastroenterol & Hepatol, Sydney, NSW, Australia
[18] Univ Porto, Fac Med, Dept Community Med Informat & Decis Hlth, Porto, Portugal
[19] Ctr Hosp Univ S Joao, Fac Med, Pathol Dept, Porto, Portugal
关键词
LYMPH-NODE METASTASIS; MUCOSAL RESECTION; METAANALYSIS; RECURRENCE; EFFICACY; CANCER; EMR;
D O I
10.1055/a-1906-8000
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding and a significant rate of noncurative procedures is expected. We aimed to assess the rate of residual lesions after a noncurative ESD for colorectal cancer (CRC) and to establish predictive scores to be applied in the clinical setting. Methods Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with noncurative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. Results From 2255 colorectal ESDs, 381 (17%) were noncurative, and 135 of these were performed in CRC lesions. A residual lesion was observed in 24 patients (18%). Surgery was performed in 96 patients and 76 (79 %) had no residual lesion in the colorectal wall or in the lymph nodes. The residual lesion rate for sm1 cancers was 0 %, and for > sm1 cancers was also 0% if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NCLymph score). Risk factors for the presence of a residual lesion in the wall were piecemeal resection, poor differentiation, and positive/indeterminate vertical margin (NC-Wall score). Conclusions Lymphatic permeation or poor differentiation warrant surgery owing to their high risk of lymph node metastasis, mainly in > sm1 cancers. In the remaining cases, en bloc and R0 resections resulted in a low risk of residual lesions in the wall. Our scores can be a useful tool for the management of patients who undergo noncurative colorectal ESDs. © 2023 Georg Thieme Verlag. All rights reserved.
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收藏
页码:235 / 244
页数:10
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