학술논문
Management of colorectal high-grade dysplasia or cancer resected by cold snare polypectomy: a multicenter exploratory study.
Document Type
Article
Author
Inoki, Kazuya; Takamaru, Hiroyuki; Furuhashi, Hiroto; Kishida, Yoshihiro; Shimodate, Yuichi; Sumida, Yorinobu; Hosotani, Kazuya; Ueyama, Hiroya; Furumoto, Yohei; Hashimoto, Shinichi; Takeuchi, Yoji; Ichijima, Ryoji; Yoshizawa, Yashiro; Suzuki, Takuto; Minoda, Yosuke; Mizukami, Kazuhiro; Matsumura, Tomoaki; Kasai, Toyotaka; Yamamura, Takeshi; Ohnita, Ken
Source
Subject
*POLYPECTOMY
*ENDOSCOPIC surgery
*DYSPLASIA
*SURGICAL excision
*COLORECTAL cancer
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Language
ISSN
0944-1174
Abstract
Background: The clinical course and surveillance strategy for patients who undergo cold snare polypectomy (CSP) for high-grade dysplasia (HGD) or cancer is unclear. We investigated the management of colorectal HGDs and cancers following CSP. Methods: This Japanese nationwide multicenter exploratory study was retrospectively conducted on patients who had undergone CSP for colorectal HGDs or cancers and follow-up colonoscopy at least once from 2014 to 2020. We investigated the detection rate of CSP scars, local recurrence rate (LRR), risk factors for local recurrence, and follow-up strategy. This study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000043670). Results: We included 155 patients with 156 lesions. CSP scars were identified in 22 (31.4%), 41 (54.7%), and 10 (90.9%) patients with curative, borderline, and non-curative resection, respectively. Among them, residual tumors were observed in one (4.5%), six (14.6%), and three (30.0%) cases, respectively. The total LRR was 13.7% (95% confidence interval: 6.8–23.8). R1 resection cases (either horizontal or vertical margins positive for tumors) were associated with local recurrence (p = 0.031). Salvage endoscopic and surgical resections were performed on 21 and 10 patients, respectively. Among them, the proportion of endoscopically suspected residual tumors was significantly higher (p < 0.001) in the residual tumor-positive group (100%) than in the residual tumor-negative group (28.6%). Conclusions: LRR after CSP for HGDs or cancers was 13.7% based on scar-identified cases. Salvage endoscopic or surgical resection should be performed according to the curability of the lesion and endoscopic findings during colonoscopic surveillance. [ABSTRACT FROM AUTHOR]