IBD 患者结直肠肿瘤的管理:当前实践与未来展望。

Monica E W Derks, Maarten Te Groen, Lisa M A van Lierop, Sanjay Murthy, David T Rubin, Talat Bessissow, Iris D Nagtegaal, Willem A Bemelman, Lauranne A A P Derikx, Frank Hoentjen
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引用次数: 0

摘要

炎症性肠病(IBD)患者罹患结直肠肿瘤(CRN)的风险增加。在这篇综述中,我们旨在提供有关 IBD 中 CRN 管理的最新概述和未来展望。内镜监测和切除技术的进步已导致肿瘤病变的内镜治疗取代手术治疗。如果完全切除可行,建议对所有 CRN 进行内镜治疗。应根据病变的复杂程度(大小、界限、形态、表面结构、粘膜下纤维化/浸润)进行标准(冷套管)息肉切除术、内镜下粘膜切除术和内镜下粘膜下剥离术,以最大限度地提高完全切除的可能性。如果无法完全切除,应由多学科团队讨论手术治疗方案。虽然(次)全切除术和直肠结肠切除术在内镜下无法切除的 CRN 的治疗中发挥着重要作用,但对于内镜下病情缓解、病变范围有限且无其他 CRN 危险因素的亚组患者,可以考虑部分结肠切除术。同步和近同步的 CRN 发生率较高,因此在治疗 CRN 后至少 5 年内都应仔细观察粘膜,并缩短间隔时间。
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Management of Colorectal Neoplasia in IBD Patients: Current Practice and Future Perspectives.

Inflammatory bowel disease [IBD] patients are at increased risk of developing colorectal neoplasia [CRN]. In this review, we aim to provide an up-to-date overview and future perspectives on CRN management in IBD. Advances in endoscopic surveillance and resection techniques have resulted in a shift towards endoscopic management of neoplastic lesions in place of surgery. Endoscopic treatment is recommended for all CRN if complete resection is feasible. Standard [cold snare] polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection should be performed depending on lesion complexity [size, delineation, morphology, surface architecture, submucosal fibrosis/invasion] to maximise the likelihood of complete resection. If complete resection is not feasible, surgical treatment options should be discussed by a multidisciplinary team. Whereas [sub]total and proctocolectomy play an important role in management of endoscopically unresectable CRN, partial colectomy may be considered in a subgroup of patients in endoscopic remission with limited disease extent without other CRN risk factors. High synchronous and metachronous CRN rates warrant careful mucosal visualisation with shortened intervals for at least 5 years after treatment of CRN.

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