Ispitivanje fakora rizika prisustva maligniteta i pojave recidiva nakon endoskopske resekcije velikih kolorektalnih polipa

Abstract

olorektalni karcinom predstavlja treći najučestaliji karcinom u razvijenim regionima sveta, i drugi vodeći uzrok smrti od karcinoma. Kolorektalni polipi, najčešće adenomatozni, predstavljaju prekursorsku leziju za pojavu karcinoma. Razvoj polipa do stadijuma karcinoma obuhvata niz promena u kojima normalni epitel debelog creva prolazi kroz više genetskih mutacija, dovodeći do citološke displazije i nastanka karcinoma. Ova transformacija adenoma u stadijum karcinoma može se prekinuti postupkom endoskopske resekcije, za koju je utvrđeno da smanjuje incidenciju i mortalitet od nastanka kolorektalnog karcinoma. Iako svaka kolorektalna neoplazija ima maligni potencijal, polipi klasifikovani kao veliki kolorektalni polipi (≥ 20 mm u dijametru) nose još veći rizik za razvoj karcinoma. CILJ: Ciljevi studije bili su: ispitati demografske i kliničke karakteristike osoba sa dijagnozom velikog kolorektalnog polipa; utvrditi prediktore prisustva maligniteta u velikim kolorektalnim polipima i prediktore pojave recidiva nakon endoskopske resekcije velikih kolorektalnih polipa tokom 2 godine praćenja. METODE: Istraživanje je sprovedeno kao kohortna studija, koja je uključila ispitanike kojima je rađena endoskopska mukozna resekcija velikih kolorektalnih polipa u Kliničko bolničkom centru „Bežanijska kosa”, u periodu od 2014. do 2020. godine, a koji su zatim praćeni u dvogodišnjem vremenskom intervalu. Na osnovu endoskopske evaluacije i klasifikacije polipa, demografskih i kliničkih karakteristika ispitanika, izvedena je jedna od sledećih procedura: endoskopska mukozna resekcija u bloku, endoskopska mukozna resekcija „parče po parče” ili operativno lečenje nakon prve kolonoskopije ili nakon nekompletne endoskopske mukozne resekcije. Tokom 2 godine nakon urađene endoskopske mukozne resekcije polipa ispitanici su bili pozivani na kontrolnu kolonoskopiju. REZULTATI: U istraživanje je uključeno ukupno 472 pacijenta sa velikim kolorektalnim polipima, predominantno muškog pola (62,9%), i prosečne starosti od 65,7±10,8 godina...

Colorectal cancer is the third most common cancer in developed regions of the world, after breast and lung cancer, and the second leading cause of cancer realted death. Colorectal polyps, usually adenomatous, represent precursor lesions of carcinoma development. The development of adenoma to the stage of carcinoma includes a series of changes in which the normal epithelium of the large intestine undergoes multiple genetic mutations, leading to cytological dysplasia and the formation of carcinoma. This transformation of the adenoma to the carcinoma can be interrupted by endoscopic resection, which has been found to reduce the incidence and mortality of colorectal cancer. Although every colorectal neoplasia has malignant potential, polyps classified as large colorectal polyps (≥ 20 mm in diameter) carry an even greater risk of developing cancer. OBJECTIVE: The objectives of the study were: to examine the demographic and clinical characteristics of persons diagnosed with a large colorectal polyp; to determine predictors of the presence of malignancy in large colorectal polyps and predictors of recurrence after endoscopic resection of large colorectal polyps during 2 years of follow-up. METHODS: The research was conducted as a cohort study, which included patients who underwent endoscopic mucosal resection of large colorectal polyps at the Clinical Hospital Center "Bežanijska kosa", from 2014 to 2020, and who were then followed up for 2 years. Based on the endoscopic evaluation and classification of polyps, demographic and clinical characteristics of the patients, one of the following procedures was performed: en bloc endoscopic mucosal resection, piece-by-piece endoscopic mucosal resection, or operative treatment after the first colonoscopy or after incomplete endoscopic mucosal resection. During 2 years after the endoscopic mucosal polyp resection, the subjects were invited to a control colonoscopy. RESULTS: A total of 472 patients with large colorectal polyps, predominantly male (62.9%), and with an average age of 65.7±10.8 years, were included in the study...