A 75-year-old male presented with difficult defecationand increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tom...A 75-year-old male presented with difficult defecationand increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tomography of the abdomen and pelvis showed extensive lymphadenopathy, a gastric mass and rectal as well as bladder wall thickening with bilateral ureterohydronephrosis. Normal looking serosal surfaces of the bladder and bowel were seen on laparoscopy and a defunctioning ileostomy was created. Gastroscopy revealed a malignant mass while cystoscopy and sigmoidscopy found extensive tumour growth lining the mucosal surfaces. Biopsies from all sites were compatible with intestinal type adenocarcinoma of gastric origin with few signet ring cells. Metabolic response to palliative chemotherapy was good and the patient's symptoms have improved on follow-up four months post ileostomy. We discuss the immunohistochemical profile of the tumour and review the literature.展开更多
Background:Colorectal carcinomas(CRCs)arise from premalignant precursors in an adenoma-carcinoma sequence,in which adenoma with high-grade dysplasia(HGD)and early-stage carcinoma are defined as advanced neoplasia.A li...Background:Colorectal carcinomas(CRCs)arise from premalignant precursors in an adenoma-carcinoma sequence,in which adenoma with high-grade dysplasia(HGD)and early-stage carcinoma are defined as advanced neoplasia.A limited number of studies have evaluated the long-term outcomes of endoscopic submucosal dissection(ESD)for advanced colorectal neoplasia.This study aimed to assess the efficacy and safety of ESD for advanced colorectal neoplasia as well as the long-term outcomes,including local recurrence and metastasis.Methods:We analyzed data collected from 610 consecutive patients with 616 advanced colorectal neoplasia lesions treated with ESD between January 2007 and December 2013.Clinical,endoscopic,and histological data were col-lected over a median follow-up period of 58 months to determine tumor stage and type,resection status,complica-tions,tumor recurrence,and distant metastasis.Results:The overall rates of en bloc resection,histological complete resection,and major complications were 94.3%,89.4%,and 2.3%,respectively.Hybrid ESD was an independent factor of piecemeal resection.Tumor location in the colon was associated with increased risk of ESD-related complications.During the follow-up period,all patients remained free of metastasis.However,local recurrence occurred in 4 patients(0.8%);piecemeal resection was a risk factor.Conclusions:ESD is effective and safe for resection of advanced colorectal neoplasia,with a high en bloc resection rate and favorable long-term outcomes.ESD is indicated for the treatment of HGD and early-stage CRC to obtain cura-tive resection and reduce local recurrence rate.展开更多
文摘A 75-year-old male presented with difficult defecationand increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tomography of the abdomen and pelvis showed extensive lymphadenopathy, a gastric mass and rectal as well as bladder wall thickening with bilateral ureterohydronephrosis. Normal looking serosal surfaces of the bladder and bowel were seen on laparoscopy and a defunctioning ileostomy was created. Gastroscopy revealed a malignant mass while cystoscopy and sigmoidscopy found extensive tumour growth lining the mucosal surfaces. Biopsies from all sites were compatible with intestinal type adenocarcinoma of gastric origin with few signet ring cells. Metabolic response to palliative chemotherapy was good and the patient's symptoms have improved on follow-up four months post ileostomy. We discuss the immunohistochemical profile of the tumour and review the literature.
基金supported by grants from the National Natural Science Foundation of China(No.81502523)grant from Shanghai Committee of Science and Technology(Nos.17140901100,16DZ2280900,and 14411950505).
文摘Background:Colorectal carcinomas(CRCs)arise from premalignant precursors in an adenoma-carcinoma sequence,in which adenoma with high-grade dysplasia(HGD)and early-stage carcinoma are defined as advanced neoplasia.A limited number of studies have evaluated the long-term outcomes of endoscopic submucosal dissection(ESD)for advanced colorectal neoplasia.This study aimed to assess the efficacy and safety of ESD for advanced colorectal neoplasia as well as the long-term outcomes,including local recurrence and metastasis.Methods:We analyzed data collected from 610 consecutive patients with 616 advanced colorectal neoplasia lesions treated with ESD between January 2007 and December 2013.Clinical,endoscopic,and histological data were col-lected over a median follow-up period of 58 months to determine tumor stage and type,resection status,complica-tions,tumor recurrence,and distant metastasis.Results:The overall rates of en bloc resection,histological complete resection,and major complications were 94.3%,89.4%,and 2.3%,respectively.Hybrid ESD was an independent factor of piecemeal resection.Tumor location in the colon was associated with increased risk of ESD-related complications.During the follow-up period,all patients remained free of metastasis.However,local recurrence occurred in 4 patients(0.8%);piecemeal resection was a risk factor.Conclusions:ESD is effective and safe for resection of advanced colorectal neoplasia,with a high en bloc resection rate and favorable long-term outcomes.ESD is indicated for the treatment of HGD and early-stage CRC to obtain cura-tive resection and reduce local recurrence rate.
