摘要
目的探讨早期结直肠癌内镜治疗后再行根治性手术患者的病理特征和疗效评价。方法回顾性收集2011年9月~2019年9月于中国医学科学院肿瘤医院既往诊断早期结直肠癌行内镜切除而后再行根治性手术患者85例的临床病理资料。分析患者临床病理特征及生存情况。结果85例患者中,有78例(91.7%)内镜治疗后患者有高危因素(比如内镜下切缘无法评价、切缘阳性、黏膜下浸润深度大于1000μm,分化差,伴脉管瘤栓及神经侵犯等)。根治术后有66例(74.2%)患者既无肿瘤残留也无淋巴结转移。有1例患者(1.2%)既有肿瘤残留又有淋巴结转移;有9例患者(10.6%)病理提示肿瘤残留;另有11例患者(12.9%)病理显示淋巴结转移。单因素统计分析显示,镜下病理伴脉管浸润易发生淋巴结转移(χ2=5.057,P=0.039)。中位随访时间24.0(P25-P75:12.0~41.1)个月。随访患者中有2例失访,余83例均无复发及转移,均生存。结论早期结直肠癌内镜切除后伴有高危因素患者的治疗需慎重考虑。伴脉管浸润可能是淋巴结转移的危险因素之一。追加外科根治手术安全可行。
Objective The purpose of this study was to investigate the pathological features and survival of 85 early stage colorectal cancer(CRC)patients who underwent endoscopy followed by radical surgery.Methods The data of 85 patients who were diagnosis as early stage CRC patient in Cancer Hospital,Chinese Academy of Medical Sciences between Sep.2011 and Sep.2019 were retrospectively collected.The clinicopathological features and survival of the patients were analyzed.Results Among the 85 patients,78(91.7%)had high risk factors after endoscopic treatment(e.g.,the endoscopic resection margin could not be evaluated,the resection margin was positive,the depth of submucosal infiltration was greater than 1000μm,the differentiation was poor,accompanied by vascular tumor thrombosis and nerve invasion,etc.).Sixty-six patients(74.2%)had neither residual tumor nor lymph node metastasis after radical resection.One patient(1.2%)had both residual tumor and lymph node metastasis.There were 9 patients(10.6%)with residual tumor.Pathological findings showed lymph node metastasis in another 11 patients(12.9%).Analysis showed that lymph node metastasis was easy to occur under the microscope with pathological accompanied by vascular infiltration(χ2=5.057,P=0.039).The median follow-up time was 24.0 months(P25-P75:12.0~41.1).Among the follow-up patients,two were lost to follow-up,and the remaining 83 patients had no recurrence or metastasis,and all survived.Conclusion The treatment of patients with high risk factors after endoscopic resection of early colorectal cancer should be carefully considered.Vascular infiltration may be one of the risk factors for lymph node metastasis.Additional radical surgery is safe and reliable.
作者
畅建平
毕建军
王征
裴炜
张文刚
王锡山
冯强
Chang Jianping;Bi Jianjun;Wang Zheng;Pei Wei;Zhang Wengang;Wang Xishan;Feng Qiang(Department of General Surgery,Linfen Central Hospital,Linfen 041000,China;Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Bejing 100021,China)
出处
《中华结直肠疾病电子杂志》
2020年第6期570-575,共6页
Chinese Journal of Colorectal Diseases(Electronic Edition)
关键词
结直肠肿瘤
根治性手术
疗效评价
内镜
Colorectal neoplasms
Radical surgery
Efficacy evaluation
Endoscopy
