Endoscopy:采用内镜下全层切除术(eFTR)治疗T1期结直肠癌的临床预后!

2021-09-07 Nebula MedSci原创

eFTR 是T1 期结直肠癌的一种相对安全有效的手术方式

内镜下完整切除和准确的组织学评估是决定 T1 期结直肠癌(CRC)后续治疗方案的关键。内镜下全层切除 (eFTR,将肿瘤连同消化道管壁全层一并切除) 是治疗 T1期直径<2cm 的结直肠癌的一种新方法。本文报告了采用 eFTR 治疗的结直肠癌的临床预后和短期结局。

Zwager等人回顾性地分析了与2015年11月至2020年4月期间在荷兰国家注册处记录的接受 eFTR 治疗的 T1 期结直肠癌病例。主要结局是技术成功和 R0 期切除。次要结局是组织学风险评估、治愈性切除、不良事件和短期结局。

手术过程图及术后病理图

共纳入了 330 例手术:132 例原发性切除和 198 例不完全 T1 期结直肠癌切除后的继发性疤痕切除。总体的技术成功率、R0 期切除率和治愈性切除率分别是 87.0% (95% CI [82.7-90.3%])、85.6% (95% CI [81.2-89.2%])和 60.3% (95% CI [54.7-65.7%])。原发性 T1 期结直肠癌根治性切除率为 23.7% (95% CI[15.9-33.6%]),排除深层黏膜下浸润为危险因素后的切除率为 60.8% (95% CI [50.4-70.4%])。99.3% 的病例可进行风险分层。重度不良事件的发生率为 2.2%。49 例 (15.3%,49/320) 进行了额外的肿瘤手术,其中 11 例 (22.4%) 的肿瘤组织未完全切干净。

治愈性切出率

200 位患者进行了内镜随访(82.6%,200/242),术后内镜随访的中位间隔时间为 4 个月,一例未完全切除的患者检查出了残留癌(0.5%)。

综上,对于可切除的小体积的 T1 期结直肠癌而言,eFTR 是一种相对安全有效的手术方式。eFTR 可拓展内镜下治疗 T1 期结直肠癌的术式选择,有助于减少过度手术治疗。未来可进一步随访长期预后情况。

原始出处:

Zwager Liselotte W,Bastiaansen Barbara,van der Spek Bas et al. Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry.[J] .Endoscopy, 2021, https://doi.org/10.1055/a-1637-9051

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