T1 结肠癌非根治性内窥镜切除术的处理方法

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Linn Bernklev , Jens Aksel Nilsen , Knut Magne Augestad , Øyvind Holme , Nastazja Dagny Pilonis
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引用次数: 0

摘要

内窥镜切除技术可对 T1 结肠癌进行全切。如果标本的组织学检查未发现淋巴结转移的高危因素,则可认为 T1 结肠癌的完全切除是治愈性的。预测淋巴结转移的标准包括粘膜下深层侵犯、分化不良、淋巴管侵犯和高级别肿瘤出芽。在这些病例中,完全(R0)的局部内镜切除被认为是足够的,因为可忽略的淋巴结转移风险并不能抵消手术切除带来的发病率和死亡率。当内镜切除不彻底(RX/R1)或存在高风险组织学特征时,就会出现挑战。根据组织学风险因素的不同,T1 CRC淋巴结转移的风险从1%到36.4%不等。任何风险因素的存在都会给患者贴上 "高风险 "的标签,因此需要进行结肠系膜淋巴结切除的肿瘤手术。然而,即使 70%-80% 的 T1-CRC 患者被归类为高危,但超过 90% 的患者在接受肿瘤手术后淋巴结未受累。T1 CRC 的手术过度治疗是一项挑战,需要在肿瘤学安全性和最大限度降低发病率/死亡率之间取得平衡。这篇叙述性综述探讨了非根治性 T1 结肠癌的管理现状,重点关注先进的内镜切除技术和手术干预之间的选择。我们讨论了监控策略和共同决策,强调了多学科方法的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of non-curative endoscopic resection of T1 colon cancer

Endoscopic resection techniques enable en-bloc resection of T1 colon cancers. A complete removal of T1 colon cancer can be considered curative when histologic examination of the specimens shows none of the high-risk factors for lymph nodes metastases. Criteria predicting lymph nodes metastases include deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding. In these cases, complete (R0), local endoscopic resection is considered sufficient as negligible risk of lymph nodes metastases does not outweigh morbidity and mortality associated with surgical resection. Challenges arise when endoscopic resection is incomplete (RX/R1) or high-risk histological features are present. The risk of lymph node metastasis in T1 CRC ranges from 1% to 36.4%, depending on histologic risk factors. Presence of any risk factor labels the patient “high risk,” warranting oncologic surgery with mesocolic lymphadenectomy. However, even if 70%–80% of T1-CRC patients are classified as high-risk, more than 90% are without lymph node involvement after oncological surgery. Surgical overtreatment in T1 CRC is a challenge, requiring a balance between oncologic safety and minimizing morbidity/mortality. This narrative review explores the landscape of managing non-curative T1 colon cancer, focusing on the choice between advanced endoscopic resection techniques and surgical interventions. We discuss surveillance strategies and shared decision-making, emphasizing the importance of a multidisciplinary approach.

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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
23
审稿时长
69 days
期刊介绍: Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology.
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