A comparative study on the clinical efficacy of endoscopic submucosal dissection in the treatment of intraluminal protruding colorectal tumors and laterally spreading tumors of the large intestine

doi:10.3877/cma.j.issn.1674-3946.2025.04.015.

Abstract

Abstract:

Objective

To understand the clinical efficacy of endoscopic submucosal dissection(ESD) in the treatment of intraluminal protruding colorectal tumors and laterally spreading tumors of the large intestine, and to analyze the risk factors affecting the complete resection rate of ESD.

Methods

Prospectively,50 patients with laterally spreading colorectal tumors with a diameter of ≥ 20 mm (group A) and 50 patients with intraluminal protruding colorectal tumors with a diameter of ≥ 20 mm (group B) who underwent ESD treatment from January 2022 to January 2024 were selected as the research subjects. The SPSS 25.0 software was used for statistical analysis of the data. Measurement data were expressed as () and analyzed by independent sample t test; Enumeration data were expressed as［ cases (%)］and compared by χ² test or Fisher’s exact probability method; Multivariate Logistic regression analysis was used to analyze the influencing factors of incomplete ESD resection. P<0.05 was considered to indicate a statistically significant difference.

Results

There were no statistically significant differences in the fibrosis classification, ESD operation time, en bloc resection rate, and ESD-related complications between the two groups of patients (P>0.05); The complete resection rate and curative resection rate of patients in group A were higher than those in group B (P<0.05);The results of univariate analysis showed that the complete resection rate of ESD for colorectal tumors was significantly correlated with the morphological characteristics of the tumor lesions and the fibrosis classification of the patients (P<0.05); The results of Logistic regression analysis showed that intraluminal protruding tumors and F2-type fibrosis were independent risk factors for incomplete ESD resection of colorectal tumors (P<0.05).

Conclusion

ESD has a good clinical efficacy in the treatment of intraluminal protruding colorectal tumors.Intraluminal protruding tumors and F2-type fibrosis are risk factors for incomplete resection of colorectal tumors.

Key words: Colorectal Neoplasms, Endoscopic Submucosal Dissection, Intracavitary Protrusion Type, Lateral Developmental Type, Comparative Effectiveness Research

Mengyuan Yang, Qixuan Bai, Xiaolin Zhao, Kun Huang, Zhen Li, Shichang Cao, Jianping Cheng. A comparative study on the clinical efficacy of endoscopic submucosal dissection in the treatment of intraluminal protruding colorectal tumors and laterally spreading tumors of the large intestine[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 405-408.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.04.015.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I04/405

Figures/Tables 4

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	冠心病（例）	糖尿病（例）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ± s ）	冠心病（例）
A组	50	22/28	64. 5±10. 7	2	12
B组	50	26/24	64. 0±10. 6	3	11
t/χ ²值		0. 641	0. 245	0. 000	0. 056
P值		0. 423	0. 807	1. 000	0. 812
组别	例数	高血压（例）	饮酒史（例）	吸烟史（例）	肿瘤长径（例）
组别	例数	高血压（例）	饮酒史（例）	吸烟史（例）	≥30mm/20～30mm
A组	50	15	12	21	12/38
B组	50	17	13	20	10/40
t/χ ²值		0. 184	0. 053	0. 041	0. 233
P值		0. 668	0. 817	0. 839	0. 629

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	冠心病（例）	糖尿病（例）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ± s ）	冠心病（例）
A组	50	22/28	64. 5±10. 7	2	12
B组	50	26/24	64. 0±10. 6	3	11
t/χ ²值		0. 641	0. 245	0. 000	0. 056
P值		0. 423	0. 807	1. 000	0. 812
组别	例数	高血压（例）	饮酒史（例）	吸烟史（例）	肿瘤长径（例）
组别	例数	高血压（例）	饮酒史（例）	吸烟史（例）	≥30mm/20～30mm
A组	50	15	12	21	12/38
B组	50	17	13	20	10/40
t/χ ²值		0. 184	0. 053	0. 041	0. 233
P值		0. 668	0. 817	0. 839	0. 629

组别	例数	ESD手术时间（例）	纤维化分型（例）	整块切除［例（%）］	ESD术后出血/穿孔（例）	完整切除［例（%）］	治愈性切除［例（%）］
组别	例数	≤40min/>40min	F0、F1/F2	整块切除［例（%）］	ESD术后出血/穿孔（例）	完整切除［例（%）］	治愈性切除［例（%）］
A组	50	12/38	42/8	49(98. 0)	1/1	48(96. 0)	48(96. 0)
B组	50	16/34	38/12	47(94. 0)	1/2	42(84. 0)	42(84. 0)
χ ²值		0. 794	1. 000	0. 260	0. 333	4. 000	4. 000
P值		0. 373	0. 317	0. 610	0. 846	0. 046	0. 046

结局	例数	病变形态	纤维化分型	肿瘤长径	ESD手术时间
结局	例数	A/B	F0、F1/F2	≥30mm/20～30mm	≤40min/>40min
非完整切除	10	2/8	5/5	3/7	3/7
完整切除	90	48/42	75/15	19/71	25/65
χ ²值		4. 000	4. 340	0. 058	0. 050
P值		0. 046	0. 037	0. 809	0. 824

指标	β 值	SE值	OR值	95%CI	P值
病变形态	1. 859	0. 867	6. 418	1. 173-35. 110	0. 032
纤维化分型	1. 751	0. 743	5. 761	1. 344-24. 702	0. 018

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