| Objective: Colorectal laterally spreading tumor(LST)is a special colorectal tumor,which is closely related to the occurrence and development of colorectal cancer.It is of great significance to understand the clinicopathological features of colorectal LST and choose appropriate treatment methods according to their different clinicopathological features.The purpose of this study was to analyze the clinicopathological features of colorectal LST and the related factors of carcinogenesis,and to explore the efficacy and safety of endoscopic treatment(EMR,ESD)in the treatment of colorectal LST.To help endoscopic physicians better identify and deal with colorectal LST,and thus contribute to early detection and treatment of colorectal LST,so as to reduce colorectal cancer-related mortality.Methods: The clinical data of patients with colorectal LST treated by endoscopy or surgery in The Second Hospital of Lanzhou University from June 2016 to June2022 were analyzed retrospectively.1.According to endoscopic classification,the patients were divided into LST-G-H,LST-G-M,LST-NG-F and LST-NG-PD groups,and then divided into colon and rectum groups according to the location of the disease.the clinicopathological differences of LST patients with different subtypes and different lesion sites were compared,and the clinicopathological features of LST were summarized,and univariate and multivariate analysis were carried out to explore the influencing factors of malignant transformation of LST.2.According to the different endoscopic treatment methods,the patients were divided into two groups: EMR and ESD,and the efficacy and safety of LST were analyzed.Results:1.A total of 224 lesions were included in 213 patients,the proportion of patients≥ 60 years old was 64.3%,and that of males was 57.7%.The most common site of the disease was the right colon(42.4%).The clinicopathological characteristics of different subtypes were different.LST-GM was the most common(107,47.8%),followed by LST-NG-F(67,29.9%),LST-GM(38,17.0%),and LST-NG-PD at least(12,5.4%).The diameter of nodules in LST-GM was larger than that in LST-GH,LST-NG-F and LST-NG-PD [2.44 ±1.13)cm,(1.63 ±0.64)cm,(1.96 ±0.63 cm)],and the difference was significant(P<0.001).The canceration rate of LST-NG-PD was the highest(75.0%),followed by LST-GM(73.8%),the canceration rate of LST-GH and LST-NG-F was lower(34.2% and 23.9%,respectively),and the difference was significant(P<0.001).The incidence of infiltrating carcinoma of LST-NG-PD(33.3%)was significantly higher than that of LST-GM(10.3%),LST-NG-F(6.0%)and LST-GH(0%),and the difference was significant(P=0.005).In terms of endoscopic classification,the incidence of LST-G-M(64.3%)in rectal was higher than that in colon(37.9%),but the incidence of LST-NG-F(16.7%)in rectal was lower than that in colon(37.9%),and the difference was significant(P<0.001).There was no significant difference in the incidence of LST-G-H and LST-NG-PD between the two groups(P>0.05).In terms of pathological features,the incidence of low-grade intraepithelial neoplasia in rectum(34.5%)was lower than that in colon(55.7%),and the incidence of high-grade intraepithelial neoplasia(56.0%)was higher than that in colon(36.4%),and the difference was significant(P =0.002 and 0.004).In addition,the incidence of submucosal invasive carcinoma of rectum(9.5%)was also higher than that of colon(7.9%),but the difference was not statistically significant(P= 0.665).Univariate analysis showed that the clinical characteristics of patients such as age,sex,BMI,smoking,drinking,diabetes,hypertension,combined colorectal polyps,history of colorectal cancer and multiple occurrence were not associated with LST carcinogenesis,but endoscopic classification(P< 0.001),lesion location(P =0.002)and lesion diameter(P<0.001)were related to LST carcinogenesis.Endoscopic classification,lesion location and lesion diameter were included in multivariate Logistic regression analysis.The results showed that the lesions were LST-NG-PD(P=0.010),LST-G-M(P<0.001)and diameter ≥2.0cm(P=0.005)was an independent risk factor for LST carcinogenesis.2.46 colorectal LST lesions were treated with EMR,and 142 colorectal LST lesions were treated with ESD.The average diameter of colorectal LST lesions treated with EMR(1.53 ±0.46cm)was smaller than that of ESD group(2.48 ±1.16 cm),and the difference was statistically significant(P< 0.001).The en bloc resection rate of ESD(93.7%)in the treatment of colorectal LST lesions was higher than that of EMR(76.1%),and the R0 resection rate of ESD(90.1%)was also significantly higher than that of EMR(73.9%),and the difference was significant(P=0.002 and 0.006).The incidences of delayed bleeding and perforation in colorectal LST lesions treated with ESD were 2.1%(3/142)and 2.8%(4/142),respectively,while no delayed bleeding and perforation were found in the EMR group.With a median follow-up of 8 months(range of 3-42 months),3 patients in the ESD group had recurrence(the recurrence rate was 2.52%).In the EMR group,with a median follow-up period of 6 months(range of 3-24 months),1 case had a recurrence(the recurrence rate was 2.63%),which was higher than that of the patients treated with ESD(2.52%),but the difference was not statistically significant(P=0.674).Conclusion:1.Colorectal LST is a special colorectal tumor with unique clinicopathologic features,which are different in different subtypes and parts.When the lesion was LST-NG-PD,LST-GM,or ≥2.0cm in diameter,it was prone to malignant degeneration.2.Both ESD and EMR can effectively treat colorectal LST,but the en bloc resection rate and R0 resection rate of colorectal LST treated by ESD are significantly higher than those of EMR,so it is an ideal method for the treatment of colorectal LST.EMR is simple to operate and has fewer complications,so it can be used as a treatment for small diameter LST lesions(<2.0cm). |
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