Outcomes of Endoscopic Resection for Colorectal Polyps With High-Grade Dysplasia or Intramucosal Cancer

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-01-01 DOI:10.1016/j.tige.2023.01.003

Sonmoon Mohapatra , Erik Almazan , Paris Charilaou , Luisa Recinos , Mehak Bassi , Arkady Broder , Kevan Salimian , Mouen A. Khashab , Saowanee Ngamruengphong

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引用次数: 0

Abstract

Background and Aims

Little is known about the outcomes of endoscopic resection (ER) for patients with colorectal adenomas (CRAs) with high-grade dysplasia (HGD) or intramucosal cancer (IMCA). This study aimed to estimate the rate of local/malignant recurrence, identify the predictive factors for local recurrence (LR), and evaluate the treatment outcomes of recurrence after ER for HGD/IMCA.

Methods

A retrospective review was performed to identify patients who underwent ER for HGD/IMCA in 2 academic medical centers. Risk factors for LR were determined by Cox regression analysis.

Results

Overall, 188 lesions with HGD/IMCA were included; 61 lesions were removed by en-bloc ER (e-ER), whereas 127 lesions were removed in a piecemeal ER (p-ER). The mean lesion size was 20.3 mm. Of the 125 patients who underwent follow-up, local adenoma recurrence occurred in 31 (23%), and malignant recurrence occurred in 2 (1.6%) patients at a median follow-up of 16 months. HGD/IMCA ≥ 4 cm removed by p-ER have the greatest hazard ratio (HR = 21.5; 95% CI 2.5-180.5; P = 0.005) for LR, compared with the HGD/IMCA < 4 cm removed by e-ER. Surgery was performed in 3.2% of patients after a complete ER, all after p-ER. Of all patients who had LR, 22.6% (7/31 patients) had recurrent adenomas despite repeat ER attempts after a mean of 1.9 ± 0.79 procedures from the index ER.

Conclusion

Our study demonstrates a high rate of LR (23%) after ER of CRAs with HGD/IMCA with a rate of malignant recurrence of 1.6%, especially after p-ER. Thus, e-ER should be preferred for these lesions whenever technically feasible.

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内镜下切除结直肠息肉伴高级别不典型增生或粘膜内癌的疗效

背景和目的对于患有高度发育不良（HGD）或粘膜内癌症（IMCA）的结直肠腺瘤（CRA）患者，内窥镜切除术（ER）的结果知之甚少。本研究旨在估计局部/恶性复发率，确定局部复发（LR）的预测因素，并评估HGD/IMCA急诊后复发的治疗结果。通过Cox回归分析确定LR的危险因素。结果共纳入188个HGD/IMCA病变；整体ER（e-ER）切除61个病灶，而零碎ER（p-ER）切除127个病灶。平均病变大小为20.3 mm。在125名接受随访的患者中，31名（23%）患者出现局部腺瘤复发，2名（1.6%）患者出现恶性复发，中位随访时间为16个月。p-ER去除≥4cm的HGD/IMCA对LR的危险比最大（HR=21.5；95%CI 2.5-180.5；p=0.005），而HGD/IMCA<；通过e-ER移除4cm。3.2%的患者在完全ER后进行了手术，全部在p-ER后进行。在所有患有LR的患者中，22.6%（7/31名患者）有复发性腺瘤，尽管在ER指数平均1.9±0.79次手术后重复进行ER尝试。结论我们的研究表明，患有HGD/IMCA的CRAs在ER后LR发生率很高（23%），恶性复发率为1.6%，尤其是在p-ER后。因此，在技术可行的情况下，e-ER应优先用于这些病变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.