Endoscopic submucosal dissection vs laparoscopic colorectal resection for early colorectal epithelial neoplasia

• 作者: Janet FY Lee Philip WY Chiu Simon SM Ng Sophie SF Hon Tiffany CL Wong Tony WC Mak WW Leung
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: EARLY COLORECTAL NEOPLASIA LAPAROSCOPIC COLECTOMY
• 年，卷（期）: 2015,（17）
• 页码范围: 1243-1249
• 页数: 7页
• 分类号: R735.34

摘要

AIM: To compare the short term outcome of endoscopic submucosal dissection(ESD) with that of laparoscopic colorectal resection(LC) for the treatment of early colorectal epithelial neoplasms that are not amenable to conventional endoscopic removal. METHODS: This was a retrospective cohort study. The clinical data of all consecutive patients who underwent ESD for endoscopically assessed benign lesions that were larger than 2 cm in diameter from 2009 to 2013 were collected. These patients were compared with a cohort of controls who underwent LC from 2005 to 2013. Lesions that were proven to be malignant by initial endoscopic biopsies were excluded. Mid and lower rectal lesions were not included because total mesorectal excision, which bears a more complicated postoperative course, is not indicated for lesions without histological proof of malignancy. Both ESD and LC were performed by the same surgical unit with a standardized technique. The patients were managed according to a standard protocol, and they were closely monitored for complications after the procedures. All hospital records were reviewed, and the following data were compared between the ESD and LC groups: patient demographics, size and location of the lesions, procedure time, shortterm clinical outcomes and pathology results. RESULTS: From 2005 to 2013, 65 patients who underwent ESD and 55 patients who underwent LC were included in this study. The two groups were similar in terms of sex(P = 0.41) and American Society of Anesthesiologist class(P = 0.58), although patients in the ESD group were slightly older(68.6 ± 9.4 vs 64.6 ± 9.9, P = 0.03). ESD could be accomplished with a shorter procedure time(113 ± 66 min vs 153 ± 43 min, P < 0.01) for lesions of comparable size(3.0 ± 1.2 cm vs 3.4 ± 1.4 cm, P = 0.22) and location(colon/rectum:59/6 vs colon/rectum: 52/3, P = 0.43). ESD appeared to be associated with a lower short-term complication rate, but the difference did not reach statistical significance(10.8% vs 23.6%, P = 0.06). In the LC arm, a tota