| Objective:To compare the results of endoscopic treatment alone versus additional surgical treatment after endoscopic treatment for colorectal high-grade epithelial neoplasia.As well as to analyze the causes and factors influencing the pathological differences before and after endoscopic treatment versus the additional surgical treatment and the causes and factors influencing the diagnostic accuracy of colorectal high-grade intraepithelial neoplasia.Methods:The clinical records and data of 53 patients with preoperative diagnosis of colorectal high-grade epithelial neoplasia(High-grade intraepithelial neoplasia,HGIN)admitted to Sino-Japanese Friendship Hospital of Jilin University from January 2019 to December 2021 were collected.The patients’ names,gender,age,size of the mass,location of the mass,morphological characteristics of the mass,clinical manifestations,and pathological findings were collected.The follow-up period was up to December 1,2022.The results of the endoscopic resection(ER)group(n=44)and the additional surgical treatment(ASR)group(n=9)for colorectal HGIN were compared.The reasons for the pathological differences before and after ER treatment and ASR treatment,the influencing factors,and the factors affecting the diagnostic accuracy of colorectal HGIN were analyzed.Results:Among 53 patients with preoperative diagnosis of colorectal HGIN admitted to Sino-Japanese Friendship Hospital of Jilin University from January 2019 to December 2021,there were 44 cases in the ER group,32 men and 12 women,with a mean age of 60.4±9.44 years.9 cases in the ASR group,5 men and 4 women,with a mean age of 62.1±6.97 years.53 patients were treated with ER and postoperatively Pathology confirmed that cancer had occurred in 30 patients.53 patients were followed up to 52 cases and 1case was lost,with a follow-up rate of 98.11%.The follow-up time ranged from 5-36 months,with a median follow-up time of 17 months.Among them,44 patients in the ER group had a recurrence of early colorectal cancer(CRC)in situ in 4 cases,Lymph node metastasis(LNM)in 1 case,death from CRC in 1 case,death from lung cancer in 1 case,and loss of follow-up in 1 case during the postoperative follow-up period.One patient died of cervical cancer during postoperative follow-up.Log Rank(Mantel-Cox)analysis showed that there was no significant difference in overall survival(OS)between the ER and ASR groups(P > 0.05),and no significant difference in disease-free survival(DFS)between the ER and ASR groups(P > 0.05).There was no significant difference between the ER and ASR groups in terms of postoperative recurrence or lymph node metastasis(P > 0.05).the mean maximum length of the mass in the ER group was 2.11 ± 0.91 cm,while that in the ASR group was 2.56 ± 0.72 cm.the cure rate was higher in the ER group compared with the ASR group for colorectal HGIN.The ER group had a higher cure rate compared with the ASR group for colorectal HGIN,while the ASR group could achieve complete cure.There was no significant difference in the incidence of postoperative complications between the two(p > 0.05).the length of hospital stay was shorter in the ER group(7.9 ± 2.0 days)than in the ASR group(15.9 ± 3.0 days).There was no significant relationship between influencing the accuracy of diagnosing colorectal HGIN and the size of the mass,single/multiple tumors,morphological characteristics of the mass,and clinical presentation of the patients(p > 0.05).In contrast,preoperative tumor location was an influential factor in the generation of differences in colorectal HGIN diagnosis(p<0.05).Conclusion:The long-term treatment effect of ER and ASR for colorectal HGIN was the same,and there was no significant difference in postoperative OS and DFS(P > 0.05).The ER group has a higher cure rate for colorectal HGIN and is the first-line treatment for colorectal HGIN,and regular postoperative follow-up observation is recommended.complete resection of the mass and final pathological staging can be obtained in the ASR group.Removal of nerves and vasculature around the mass with possible metastasis and infiltration reduces the rate of local recurrence and distant metastasis.Additional surgical treatment is recommended for patients suspected of carcinoma.pathological findings before and after ER and ASR treatment differ greatly,and more than half of the patients have developed carcinoma after ER treatment.There is a direct relationship with the site and number of endoscopic biopsies,the pathologist’s diagnosis and the treatment modality chosen by endoscopy.The presence of solitary/multiple,size of the mass,morphological characteristics of the mass and clinical presentation of the patient are not influential factors in the differential diagnosis of colorectal HGIN and early CRC.In contrast,lesion tissue located in the rectum and sigmoid colon are the two sites with higher occurrence of carcinoma in colorectal HGIN,and the misdiagnosis rate is higher.Especially when the lesion tissue is located in low rectal cancer,different treatment methods have different effects on the function of the anal sphincter.Therefore,patients with HGIN with lesions located in low rectum should pay special attention to this and should refer to other auxiliary examinations to determine whether cancer has occurred and choose the appropriate treatment method. |
