Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer,Annals of Surgical Oncology

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Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer
Annals of Surgical Oncology ( IF 3.4 ) Pub Date : 2023-01-04 , DOI: 10.1245/s10434-022-12973-4
Julia Hanevelt ₁ , Leon M G Moons ₂ , Judith E K R Hentzen ₃ , Tess M Wemeijer ₃ , Jelle F Huisman ₁ , Wouter H de Vos Tot Nederveen Cappel ₁ , Henderik L van Westreenen ₃

Affiliation

Background

Local en bloc resection of pT1 colon cancer has been gaining acceptance during the last few years. In the absence of histological risk factors, the risk of lymph-node metastases (LNM) is negligible and does not outweigh the morbidity and mortality of an oncologic resection. Colonoscopy-assisted laparoscopic wedge resection (CAL-WR) has proved to be an effective and safe technique for removing complex benign polyps. The role of CAL-WR for the primary resection of suspected T1 colon cancer has to be established.

Methods

This retrospective study aimed to determine the radicality and safety of CAL-WR as a local en bloc resection technique for a suspected T1 colon cancer. Therefore, the study identified patients in whom high-grade dysplasia or a T1 colon carcinoma was suspected based on histology and/or macroscopic assessment, requiring an en bloc resection.

Results

The study analyzed 57 patients who underwent CAL-WR for a suspected macroscopic polyp or polyps with biopsy-proven high-grade dysplasia or T1 colon carcinoma. For 27 of these 57 patients, a pT1 colon carcinoma was diagnosed at pathologic examination after CAL-WR. Histological risk factors for LNM were present in three cases, and 70% showed deep submucosal invasion (Sm2/Sm3). For patients with pT1 colon carcinoma, an overall R0-resection rate of 88.9% was achieved. A minor complication was noted in one patient (1.8%).

Conclusions

The CAL-WR procedure is an effective and safe technique for suspected high-grade dysplasia or T1-colon carcinoma. It may fill the gap for tumors that are macroscopic suspected for deep submucosal invasion, providing more patients an organ-preserving treatment option.

中文翻译：

结肠镜辅助腹腔镜楔形切除术治疗疑似 T1 结肠癌

背景

在过去几年中，pT1 结肠癌的局部整块切除术已获得认可。在没有组织学风险因素的情况下，淋巴结转移 (LNM) 的风险可以忽略不计，并且不会超过肿瘤切除术的发病率和死亡率。结肠镜辅助腹腔镜楔形切除术 (CAL-WR) 已被证明是去除复杂良性息肉的有效且安全的技术。必须确定 CAL-WR 在初次切除疑似 T1 结肠癌中的作用。

方法

这项回顾性研究旨在确定 CAL-WR 作为疑似 T1 结肠癌局部整块切除技术的激进性和安全性。因此，该研究确定了根据组织学和/或宏观评估怀疑高度异型增生或 T1 结肠癌的患者，需要整块切除。

结果

该研究分析了 57 名接受 CAL-WR 的患者，这些患者因疑似肉眼可见息肉或经活检证实为高度异型增生或 T1 结肠癌的息肉而接受了 CAL-WR。对于这 57 名患者中的 27 名，pT1 结肠癌在 CAL-WR 后的病理检查中被诊断出来。3 个病例存在 LNM 的组织学危险因素，70% 显示深粘膜下浸润 (Sm2/Sm3)。对于 pT1 结肠癌患者，总体 R0 切除率为 88.9%。一名患者 (1.8%) 出现轻微并发症。