文章：

早期结直肠癌患者内镜黏膜下剥离术后追加手术的疗效分析

Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients

原文发布日期：9 September 2023

DOI: 10.3390/cancers15184490

类型: Article

开放获取: 是

英文摘要：

T1 colorectal cancers (T1CRC) are increasingly being treated by endoscopic submucosal dissection (ESD). After ESD of a T1CRC, completion surgery is indicated in a subgroup of patients. Currently, the influence of ESD on surgical morbidity and mortality is unknown. The aim of this study was to compare 90-day morbidity and mortality of completion surgery after ESD to primary surgery. The completion surgery group consisted of suspected T1CRC patients from a multicenter prospective ESD database (2014–2020). The primary surgery group consisted of pT1CRC patients from a nationwide surgical registry (2017–2019). Patients with rectal or sigmoidal cancers were selected. Patients receiving neoadjuvant therapy were excluded. Propensity score adjustment was used to correct for confounders. In total, 411 patients were included: 54 in the completion surgery group (39 pT1, 15 pT2) and 357 in the primary surgery group with pT1CRC. Adverse event rate was 24.1% after completion surgery and 21.3% after primary surgery. After completion surgery 90-day mortality did not occur, though one patient died in the primary surgery group. After propensity score adjustment, lymph node yield did not differ significantly between the groups. Among other morbidity-related outcomes, stoma rate (OR 1.298 95%-CI 0.587-2.872,p= 0.519) and adverse event rate (OR 1.162; 95%-CI 0.570-2.370,p= 0.679) also did not differ significantly. A subgroup analysis was performed in patients undergoing rectal surgery. In this subgroup (37 completion and 136 primary surgery), these morbidity outcomes also did not differ significantly. In conclusion, this study suggests that ESD does not compromise morbidity or 90-day mortality of completion surgery.

摘要翻译： 

T1期结直肠癌（T1CRC）越来越多地通过内镜黏膜下剥离术（ESD）进行治疗。对于部分T1CRC患者，在ESD后仍需进行补充性手术。目前，ESD对手术并发症发生率和死亡率的影响尚不明确。本研究旨在比较ESD后补充性手术与直接手术的90天并发症发生率和死亡率。补充性手术组患者来源于一项多中心前瞻性ESD数据库（2014-2020年）中疑似T1CRC的患者。直接手术组患者来源于全国性手术登记系统（2017-2019年）中病理确诊为pT1CRC的患者。研究纳入直肠癌或乙状结肠癌患者，排除接受新辅助治疗者。采用倾向性评分调整法校正混杂因素。共纳入411例患者：补充性手术组54例（39例pT1，15例pT2），直接手术组357例（均为pT1CRC）。补充性手术后不良事件发生率为24.1%，直接手术后为21.3%。补充性手术组无90天死亡病例，直接手术组有1例死亡。经倾向性评分调整后，两组淋巴结检出数量无显著差异。其他与并发症相关的指标中，造口率（OR 1.298，95%CI 0.587-2.872，p=0.519）和不良事件发生率（OR 1.162，95%CI 0.570-2.370，p=0.679）亦无显著差异。对接受直肠手术的患者进行亚组分析显示（37例补充性手术，136例直接手术），上述并发症指标同样无显著差异。结论：本研究表明，ESD不会增加补充性手术的并发症发生率或90天死亡率。

原文链接：

Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients