Laparoscopic-facilitated endoscopic submucosal dissection, mucosal resection, and partial circumferential ('wedge') colon wall resection for benign colorectal neoplasms that come to surgery

摘要

Background. Large polyps that come to surgery are removed via colectomy (CR). Alternatives are MIS-facilitated endoscopic submucosal dissection/endoscopic mucosal resection (ESD/EMR) or wedge resection (WR). This study presents the results of 26 polyp patients who had minimally invasive surgery (MIS)-monitored ESD/EMR, WR, or if necessary, standard CR. Methods. The authors used a retrospective review of 1 surgeon's experience. ESD/EMR was the first choice, WR was the second, and CR was the last resort. Results. Polyp locations were as follows: right/transverse, 16 (62%); rectum, 7 (27%); and left/sigmoid, 3 (12%). ESD/EMR was successful in 13 patients and WR in 4; 9 patients required CR. Median flatus times were as follows: ESD/EMR, 1 day; WR, 2 days; and CR, 3 days (ESD/EMR vs CR, P =.01). Median length of stay was as follows: ESD/EMR, 3 days; WR, 5 days; and CR, 5 days (ESD/EMR vs CR, P =.0037). There were no leaks or abscesses. Carcinoma was found in 3 patients. Postoperatively, 2 ESD/EMR patients had residual polyp fully removed via a scope. Conclusions. ESD/EMR and WR appear to be safe but techniques are evolving. Larger studies are needed.