大腸黏膜內癌之惡性息肉切除後的長期追蹤研究

研究目的：大腸癌發生率現為癌症發生率第一名，早期發現早期治療甚為重要。隨著近年糞便潛血檢查及大腸鏡篩檢的普及，越來越多的早期癌病灶被發現。利用內視鏡技術(Polypectomy，EMR，ESD)將大腸黏膜內癌(Tis)息肉切除，可視為cured therapy，也甚為普遍。然而後續的追蹤及癌症復發率，特別是本地的資料,仍舊不多。研究方法及資料： 利用癌症資料登記庫，分析自民國96年10月至民國104年3月，於中山醫學大學附設醫院接受大腸鏡檢查發現惡性息肉，利用polypectomy， EMR，或ESD等內視鏡方式切除後，病理診斷為大腸Tis的adenocarcinoma之患者。每個息肉的組織型態，位置，追蹤時間，復發率，死亡率，以及接受大腸鏡檢查的原因，都有詳細的記載。研究結果： 一共98個患者在接受大腸鏡息肉切除術後診斷為大腸Tis的adenocarcinoma。平均年齡為62.6歲，平均追蹤時間2.62年(0.2 ~ 7年) ，共有4個人死亡。沒有患者在後續的追蹤發現有大腸癌復發，而有3位患者在後續的追蹤發現有癌前病變( high grade dysplasia )的息肉。平均追蹤的大腸鏡次數為1.4次(0 ~ 5次) 。 在4個死亡的患者當中，沒有一個有接受過後續的大腸鏡檢查，而其死亡原因也都與大腸癌無關。結論與建議：在我們的研究裡,於第一次大腸鏡檢查後診斷為Tis大腸惡性息肉並接受內視鏡方式切除息肉的患者,在平均2.62年的追蹤後,癌症復發率為0%.對於Tis大腸惡性息肉的患者,利用內視鏡技術的息肉切除可視為一cured的治療方式。

Objective： The incidence of colorectal cancer incidence is now number one in Taiwan, thus early detection and early treatment is important. With the recent popularity of fecal occult blood test and colonoscopy screening, an increasing number of early colorectal cancer lesions were found. The use of endoscopic techniques (Polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD)) in treating Tis colorectal adenocarcinoma can be considered as cured therapy. However, post treatment follow-up and the recurrence rate, especially local data, is still a lack of information.Methods and Materials：By using Taiwan Cancer Registry Database, from 2007/10 to 2015/3 in Chung Shan Medical University Hospital, people received colonoscopy with a finding of malignant polyps and treated by endoscopic techniques such as polypectomy, endoscopic mucosal resection, or endoscopic submucosal dissection, the pathology revealed adenocarcinoma of colon, Tis, are included. Each polyp histopathological features, location, follow-up time, recurrence rate, mortality, and the reasons for acceptance of colonoscopy, are well documented.Results： A total of 98 patients received colonoscopic polypectomy (including EMR and ESD) after a diagnosis of Tis colorectal adenocarcinoma. The mean age was 62.6 years, and the mean follow up time was 2.62 years (0.2 to 7 years). A total of four people died. None of the patients found of colorectal cancer recurrence in the subsequent surveillance, while three patients found to have precancerous polyps (high grade dysplasia). The mean number of times of follow up colonoscopy was 1.4 (0-5). In the four patients who died, no one has received a follow up colonoscopy. The cause of death has nothing to do with colorectal cancer, however.Conclusion and Suggestion：In our study, we analyzed patients diagnosed as Tis colorectal malignant polyps and received endoscopic removal of polyps. After an mean of 2.62 years follow up, the cancer recurrence rate was 0%. For patients with Tis colorectal adenocarcinoma polyps, using endoscopic techniques (polypectomy, EMR, ESD) can be regarded as a cured treatment.