대장종양 절제 시 점막하박리술과 점막하박리술-올가미 병용 절제술의 장기 예후 비교

Abstract

Background and aims: Few studies have addressed the long-term outcomes of hybrid endoscopic submucosal dissection (ESD-H) in the colorectum. We did so in our current study in comparison with a conventional colorectal ESD approach in which submucosal dissection was continued throughout, until the completion of resection (ESD-T). Method: The medical records of 836 colorectal neoplasia patients treated by ESD-T or ESD-H were reviewed retrospectively. ESD-H was defined as colorectal ESD with additional snaring in the final stage of the procedure. Primary outcomes were the overall and metastatic recurrence rates. Secondary outcomes were short-term outcomes such as the en bloc resection rate, procedure time and adverse events. Result: The overall recurrence rate was higher in the ESD-H than in the ESD-T group (5.7% vs 0.7%, p = 0.001). The metastatic recurrence rate showed no significant difference between these groups (1.4% vs 1.4%, p = 1.000). Multivariate analysis revealed that a failed en bloc resection (HR 24.097, 95% CI 5.446-106.237; p < 0.001) and larger tumor size (HR 1.042 95% CI 1.014-1.070; p = 0.003) were independently associated with overall recurrence. The ESD-H group showed a lower en bloc resection rate (56.8% vs 96.5%, p < .001), shorter procedure time (45.6 vs 54.3 min, P < .001) and higher perforation rate (10.3% vs 6.0%, p = .029). Conclusion: Although long-term outcomes in terms of overall recurrence are inferior following ESD-H, a failed en bloc resection and large tumor size are the only independent risk factors for recurrence. Further investigations are warranted to improve the long-term outcomes of ESD-H.