{"title":"内镜粘膜下剥离术对位于肛门直肠交界处的病变安全有效：欧洲两家转诊中心的分析","authors":"Mariana Figueiredo Ferreira, Margarida Marques, Rui Morais, Arnaud Lemmers, Guilherme Macedo, João Santos-Antunes","doi":"10.1159/000528107","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic submucosal dissection (ESD) is a well-established resection technique for colorectal superficial tumors, but its role in the treatment of anorectal junction (ARJ) lesions still remains to be determined. With this study, we aimed to evaluate the feasibility, safety, and efficacy of ESD for the resection of ARJ lesions, in comparison to more proximal rectal lesions.</p><p><strong>Methods: </strong>We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021.</p><p><strong>Results: </strong>A total of two hundred and fifty-two rectal lesions were included. Sixty (24%) were ARJ lesions, and the remaining 192 (76%) were located proximally. Technical success was achieved in 248 procedures (98%), and its rate was similar in both locations (<i>p</i> = 0.246). Most of the lesions presented high-grade dysplasia/Tis adenocarcinoma (54%); 36 (15%) had submucosal adenocarcinoma, including 20 superficial (sm1) and 16 deeply invasive (>SM1) T1 cancers. We found no differences between ARJ and rectal lesions in regard to <i>en bloc</i> resection rate (100% vs. 96%, <i>p</i> = 0.204), R0 resection rate (76% vs. 75%, <i>p</i> = 0.531), curative resection rate (70% vs. 70%, <i>p</i> = 0.920), procedures' median duration (120 min vs. 90 min, <i>p</i> = 0.072), ESD velocity (14 vs. 12 mm<sup>2</sup>/min, <i>p</i> = 0.415), histopathology result (<i>p</i> = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, <i>p</i> = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, <i>p</i> = 0.709), perforation (0% vs. 5%, <i>p</i> = 0.075), or the need for readmission (2% vs. 2%, <i>p</i> = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, <i>p</i> = 0.003) and anorectal pain (9% vs. 1%, <i>p</i> = 0.002) were significantly more frequent in ARJ lesions.</p><p><strong>Conclusion: </strong>ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":1.0000,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10928857/pdf/","citationCount":"0","resultStr":"{\"title\":\"Endoscopic Submucosal Dissection Is Safe and Effective for Lesions Located at the Anorectal Junction: Analysis from Two Referral European Centers.\",\"authors\":\"Mariana Figueiredo Ferreira, Margarida Marques, Rui Morais, Arnaud Lemmers, Guilherme Macedo, João Santos-Antunes\",\"doi\":\"10.1159/000528107\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Endoscopic submucosal dissection (ESD) is a well-established resection technique for colorectal superficial tumors, but its role in the treatment of anorectal junction (ARJ) lesions still remains to be determined. With this study, we aimed to evaluate the feasibility, safety, and efficacy of ESD for the resection of ARJ lesions, in comparison to more proximal rectal lesions.</p><p><strong>Methods: </strong>We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021.</p><p><strong>Results: </strong>A total of two hundred and fifty-two rectal lesions were included. Sixty (24%) were ARJ lesions, and the remaining 192 (76%) were located proximally. Technical success was achieved in 248 procedures (98%), and its rate was similar in both locations (<i>p</i> = 0.246). Most of the lesions presented high-grade dysplasia/Tis adenocarcinoma (54%); 36 (15%) had submucosal adenocarcinoma, including 20 superficial (sm1) and 16 deeply invasive (>SM1) T1 cancers. We found no differences between ARJ and rectal lesions in regard to <i>en bloc</i> resection rate (100% vs. 96%, <i>p</i> = 0.204), R0 resection rate (76% vs. 75%, <i>p</i> = 0.531), curative resection rate (70% vs. 70%, <i>p</i> = 0.920), procedures' median duration (120 min vs. 90 min, <i>p</i> = 0.072), ESD velocity (14 vs. 12 mm<sup>2</sup>/min, <i>p</i> = 0.415), histopathology result (<i>p</i> = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, <i>p</i> = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, <i>p</i> = 0.709), perforation (0% vs. 5%, <i>p</i> = 0.075), or the need for readmission (2% vs. 2%, <i>p</i> = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, <i>p</i> = 0.003) and anorectal pain (9% vs. 1%, <i>p</i> = 0.002) were significantly more frequent in ARJ lesions.</p><p><strong>Conclusion: </strong>ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.</p>\",\"PeriodicalId\":51838,\"journal\":{\"name\":\"GE Portuguese Journal of Gastroenterology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2023-01-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10928857/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"GE Portuguese Journal of Gastroenterology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1159/000528107\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"GE Portuguese Journal of Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000528107","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
简介：内镜粘膜下剥离术（ESD）是一种行之有效的结直肠浅表肿瘤切除技术，但它在治疗肛门直肠交界处（ARJ）病变中的作用仍有待确定。通过这项研究，我们旨在评估ESD用于切除ARJ病变的可行性、安全性和有效性，并与更近端直肠病变进行比较：我们对前瞻性收集的 2015 年至 2021 年期间在两个欧洲中心进行的所有连续直肠ESD手术数据进行了回顾性分析：结果：共纳入252例直肠病变。其中60例（24%）为ARJ病变，其余192例（76%）位于近端。248例手术（98%）取得了技术成功，两个部位的成功率相似（P = 0.246）。大多数病变为高级别发育不良/Tis腺癌（54%）；36 例（15%）为粘膜下腺癌，其中包括 20 例浅表（sm1）和 16 例深度浸润（>SM1）T1 癌。我们发现 ARJ 和直肠病变在全切率（100% vs. 96%，P = 0.204）、R0 切除率（76% vs. 75%，P = 0.531）、根治性切除率（70% vs. 70%，P = 0.920）、手术中位持续时间（120 分钟 vs. 90 分钟，p = 0.072）、ESD 速度（14 mm2/min vs. 12 mm2/min，p = 0.415）、组织病理学结果（p = 0.053）以及因非治愈性 ESD 而需要手术的比例（5% vs. 3%，p = 0.739）。此外，在延迟出血（7% vs. 8%，p = 0.709）、穿孔（0% vs. 5%，p = 0.075）或需要再次入院（2% vs. 2%，p = 0.939）方面也没有明显的统计学差异。然而，肛门直肠狭窄（5% 对 0%，p = 0.003）和肛门直肠疼痛（9% 对 1%，p = 0.002）在 ARJ 病变中的发生率明显更高：结论：ESD是治疗位于ARJ的直肠病变的一种安全有效的切除技术。
Endoscopic Submucosal Dissection Is Safe and Effective for Lesions Located at the Anorectal Junction: Analysis from Two Referral European Centers.
Introduction: Endoscopic submucosal dissection (ESD) is a well-established resection technique for colorectal superficial tumors, but its role in the treatment of anorectal junction (ARJ) lesions still remains to be determined. With this study, we aimed to evaluate the feasibility, safety, and efficacy of ESD for the resection of ARJ lesions, in comparison to more proximal rectal lesions.
Methods: We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021.
Results: A total of two hundred and fifty-two rectal lesions were included. Sixty (24%) were ARJ lesions, and the remaining 192 (76%) were located proximally. Technical success was achieved in 248 procedures (98%), and its rate was similar in both locations (p = 0.246). Most of the lesions presented high-grade dysplasia/Tis adenocarcinoma (54%); 36 (15%) had submucosal adenocarcinoma, including 20 superficial (sm1) and 16 deeply invasive (>SM1) T1 cancers. We found no differences between ARJ and rectal lesions in regard to en bloc resection rate (100% vs. 96%, p = 0.204), R0 resection rate (76% vs. 75%, p = 0.531), curative resection rate (70% vs. 70%, p = 0.920), procedures' median duration (120 min vs. 90 min, p = 0.072), ESD velocity (14 vs. 12 mm2/min, p = 0.415), histopathology result (p = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, p = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, p = 0.709), perforation (0% vs. 5%, p = 0.075), or the need for readmission (2% vs. 2%, p = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, p = 0.003) and anorectal pain (9% vs. 1%, p = 0.002) were significantly more frequent in ARJ lesions.
Conclusion: ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.
期刊介绍：
The ''GE Portuguese Journal of Gastroenterology'' (formerly Jornal Português de Gastrenterologia), founded in 1994, is the official publication of Sociedade Portuguesa de Gastrenterologia (Portuguese Society of Gastroenterology), Sociedade Portuguesa de Endoscopia Digestiva (Portuguese Society of Digestive Endoscopy) and Associação Portuguesa para o Estudo do Fígado (Portuguese Association for the Study of the Liver). The journal publishes clinical and basic research articles on Gastroenterology, Digestive Endoscopy, Hepatology and related topics. Review articles, clinical case studies, images, letters to the editor and other articles such as recommendations or papers on gastroenterology clinical practice are also considered. Only articles written in English are accepted.
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