Abdullah Murat BUYRUK, Ayten LİVANOĞLU, Aydın AKTAŞ

Kolorektal lateral yayılımlı tümörlerde başarısız endoskopik mukozal rezeksiyon sonrası endoskopik submukozal diseksiyonun uygulanabilirliği: tek merkez deneyimi

Amaç: Geniş kolorektal lateral yayılımlı tümörlerin tedavisinde endoskopik mukozal rezeksiyon bazı durumlarda teknik olarak başarısız (tamamlanmamış endoskopik mukozal rezeksiyon) olabilir. Endoskopik mukozal rezeksiyon tamamlanmamış tümörlerde endoskopik submukozal diseksiyon yönteminin uygulanabilirliği ile ilgili literatürde kısıtlı veri mevcuttur. Biz bu çalışmada tamamlanmamış endoskopik mukozal rezeksiyon sonrasında endoskopik submukozal diseksiyon uyguladığımız kolorektal lateral yayılımlı tümörlü hastaların sonuçlarını analiz ettik. Gereç ve Yöntem: Şubat 2019- Nisan 2021 tarihleri arasında endoskopik mukozal rezeksiyon tamamlanmamış kolorektal lateral yayılımlı tümörlerde endoskopik submukozal diseksiyon uygulanan 8 hasta çalışmaya dahil edildi. Primer sonlanım noktası olarak endoskopik submukozal diseksiyon ile en bloc, R0 ve küratif rezeksiyon oranlarına bakıldı.Bulgular: Tüm hastalarda endoskopik submukozal diseksiyon başarı ile tamamlandı. Ortalama tümör çapı 61,5 mm (35-100 mm) idi. En bloc, R0 ve küratif rezeksiyon oranları sırayla %100, %87,5 ve %87,5’du. Uygulama esnasında perforasyon bir (%12,5) hastada görüldü ve klip uygulanarak tedavi edildi. Gecikmiş kanama bir (%12,5) hastada izlendi ve endoluminal hemostaz sağlandı. Histopatolojik incelemede lateral yayılımlı tümörlerin dördünde (%50,0) submukozal invazyon izlendi. Derin submukozal invazyon nedeniyle bir hastada endoskopik submukozal diseksiyon sonrasında cerrahi rezeksiyon uygulandı. Sonuç: Endoskopik mukozal rezeksiyon tamamlanmamış kolorektal lateral yayılımlı tümörlerde endoskopik submukozal diseksiyon etkili ve oldukça güvenilir bir yöntemdir.

Applicability of endoscopic submucosal dissection after unsuccessful endoscopic mucosal resection in colorectal laterally spreading tumors: a single center experience

Aim: Endoscopic mucosal resection might technically be unsuccessful (interrupted endoscopic mucosal resection) in some cases when treating large colorectal laterally spreading tumors. In the literature, data on the outcomes of the endoscopic submucosal dissection method in endoscopic mucosal resection interrupted tumors are lacking. In this study, we evaluated the results of patients who underwent endoscopic submucosal dissection for endoscopic mucosal resection interrupted laterally spreading tumors. Materials and Methods: Between February 2019 and April 2021, 8 patients with endoscopic mucosal resection interrupted colorectal laterally spreading tumors underwent endoscopic submucosal dissection. The primary endpoint was en bloc, R0, and curative resection rates of endoscopic submucosal dissection. Results: In all cases, endoscopic submucosal dissection was successfully completed. The mean tumor size was 61.5 mm (35–100 mm). The rate of en bloc resection, R0 resection and curative resection was 100%, 87.5% and 87.5% respectively. Intra-procedural perforation occurred in 1 patient (12.5%) and was successfully treated with clip application. Delayed bleeding occurred in 1 patient (12.5%), and was successfully treated with endoluminal hemostasis. Furthermore, histopathological examination revealed that laterally spreading tumors in 4 patients (50.0%) had submucosal invasion. Surgical resection was performed after endoscopic submucosal dissection in 1 patient owing to the presence of deep submucosal invasion. Conclusion: Endoscopic submucosal dissection is an effective and relatively safe method in endoscopic mucosal resection interrupted colorectal laterally spreading tumors.

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