Local excision is gaining acceptance as standard treatment for T1 colon cancer (CC); however, not all patients are eligible for endoscopic resection. Colonoscopy-assisted laparoscopic wedge resection (CAL-WR) is a relatively new technique that could fill the gap between endoscopic resection and major surgery. The aim of this study was to analyze the oncological safety of CAL-WR for CC. Methods: A retrospective cohort study was performed, including patients that underwent CAL-WR for CC. Exclusion criteria were double tumors, <1 year follow-up, previous other colorectal malignancy, inflammatory bowel disease or synchronous metastases. The primary outcome was disease recurrence and the secondary outcome was overall survival. Results: Fifty-three patients were included; 35 patients were diagnosed with T1 CC. CAL-WR was radical (R0) for all T1 CC in 94.3% and 94.7% for tumors with deep submucosal invasion (sm2-3 Kikuchi). The mean follow-up was 3.3 years (Q1: 2.0; Q3: 4.3) for disease recurrence and 4.2 years (Q1: 2.8; Q3: 5.2) for overall survival. None of the patients with T1 CC had disease recurrence or died due to their malignancy. There were 14 patients with a T2 and 4 patients with a T3 CC, 17/18 patients underwent completion surgery. Three patients with T2 and one with T3 CC developed a locoregional recurrence (peritoneal). One patient with T3 CC developed lung metastases. Two patients with T3 and one with T2 CC died due to their malignancy. Conclusions: This study suggests that CAL-WR is oncologically safe as treatment for T1 CC. The safety of incidental CAL-WR for >T1 CC, followed by completion surgery, remains unclear. Prospective studies are needed to evaluate these results.
局部切除术作为T1期结肠癌（CC）的标准治疗方式正逐渐获得认可，然而并非所有患者都适合接受内镜下切除。结肠镜辅助腹腔镜楔形切除术（CAL-WR）作为一种相对新兴的技术，有望填补内镜切除与大型外科手术之间的空白。本研究旨在分析CAL-WR治疗结肠癌的肿瘤学安全性。方法：开展回顾性队列研究，纳入接受CAL-WR治疗的结肠癌患者。排除标准包括：多原发肿瘤、随访时间不足1年、既往有其他结直肠恶性肿瘤病史、炎症性肠病或同时性转移。主要研究终点为疾病复发，次要终点为总生存期。结果：共纳入53例患者，其中35例确诊为T1期结肠癌。CAL-WR对所有T1期肿瘤的根治性切除（R0）率达94.3%，对深层黏膜下浸润（sm2-3 Kikuchi分级）肿瘤的R0切除率达94.7%。疾病复发的中位随访时间为3.3年（四分位距：2.0-4.3），总生存期的中位随访时间为4.2年（四分位距：2.8-5.2）。所有T1期结肠癌患者均未出现疾病复发或死于恶性肿瘤。研究包含14例T2期和4例T3期结肠癌患者，其中17/18例接受了补充根治手术。3例T2期和1例T3期患者出现局部区域（腹膜）复发，1例T3期患者发生肺转移，2例T3期和1例T2期患者死于恶性肿瘤。结论：本研究表明CAL-WR作为T1期结肠癌的治疗手段具有肿瘤学安全性。对于术中意外发现的＞T1期结肠癌行CAL-WR后补充根治手术的安全性仍不明确，需开展前瞻性研究进一步验证。
肿瘤(癌症)患者之家