gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2021-20-2-50-56gnck-1633Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФакторы, лимитирующие выполнение подслизистой диссекции в толстой кишкеFactors limiting the endoscopic submucosal dissection in colorectal tumorshttps://orcid.org/0000-0001-5848-4050ЛикутовА. А.LikutovA. A.

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

ул. Баррикадная, д. 2/1, стр. 1, г. Москва, 125993, Россия

SPIN-код: 3866-1224, AuthorID: 804133

Alexey A. Likutov

Salyama Adilya str., 2, Moscow, 123423, Russia,

Barrikadnaya str., 2/1–1, Moscow, Russia

a.likutov@yandex.ruhttps://orcid.org/0000-0003-3258-7881МтвралашвилиД. А.MtvralashviliD. A.

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

SPIN-код: 1999-8634

Dmitry A. Mtvralashvili

Salyama Adilya str., 2, Moscow, 123423, Russia,

https://orcid.org/0000-0002-0735-2100НагудовМ. А.NagudovM. A.

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

SPIN-код: 4861-1156, AuthorID: 969681

Marat A. Nagudov

Salyama Adilya str., 2, Moscow, 123423, Russia,

https://orcid.org/0000-0003-4679-5497ЮгайО. М.YugaiO. M.

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

Oleg M. Yugai

Salyama Adilya str., 2, Moscow, 123423, Russia,

https://orcid.org/0000-0003-4872-4481ВагановЮ. Е.VaganovYu. E.

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

SPIN-код: 5399-5218, AuthorID: 68984

Yuri E. Vaganov

Salyama Adilya str., 2, Moscow, 123423, Russia,

https://orcid.org/0000-0002-6212-9454ЧернышовС. В.ChernyshovS. V.

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

Stanislav V. Chernyshov

Salyama Adilya str., 2, Moscow, 123423, Russia,

https://orcid.org/0000-0001-8189-3071МайновскаяО. А.MainovskayaO. A.

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

Olga A. Mainovskaya

Salyama Adilya str., 2, Moscow, 123423, Russia,

ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава России; ФГБОУ ДПО РМАНПО Минздрава РоссииРоссияRyzhikh National Medical Research Center of Coloproctology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of RussiaRussian FederationФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Center of ColoproctologyRussian Federation2021210620212025056Copyright © Ликутов А.А., Мтвралашвили Д.А., Нагудов М.А., Югай О.М., Ваганов Ю.Е., Чернышов С.В., Майновская О.А., 20212021Ликутов А.А., Мтвралашвили Д.А., Нагудов М.А., Югай О.М., Ваганов Ю.Е., Чернышов С.В., Майновская О.А.Likutov A.A., Mtvralashvili D.A., Nagudov M.A., Yugai O.M., Vaganov Y.E., Chernyshov S.V., Mainovskaya O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1633Цель

Цель: выявление факторов риска конверсии эндоскопической подслизистой диссекции в трансабдоминальное вмешательство.

Пациенты и методы

Пациенты и методы: в проспективное когортное исследование были включены 405 пациентов (166 (40,9%) мужчин и 239 (59,1%) женщин, средний возраст — 66 (59; 72) лет), которым была выполнена эндоскопическая подслизистая диссекция эпителиальных новообразований толстой кишки.

Результаты

Результаты: средний размер удаленных новообразований составил 3,0 (2,4; 4) см, единым блоком опухоль удалена в 324/363 (89,2%) случаях, а R0 границы резекции отмечены в 218/324 (67,3%) наблюдениях. Статистически значимыми факторами риска конверсии являются: размер опухоли ≥ 3,2 см (ОШ 2,9; 95% ДИ: 1,2–7,1, р = 0,017), лифтинг ≤ 3 мм (ОШ 41; 95% ДИ: 15–105, р = 0,000002) и сосудистый рисунок опухоли IIIa по Sano (ОШ 4,0; 95% ДИ: 1,3–11,9, р = 0,013).

Заключение

Заключение: эндоскопическая диссекция в подслизистом слое является безопасным способом удаления новообразований толстой кишки. Вместе с тем, наличие факторов риска конверсии может повлиять на результат эндоскопического лечения пациентов.

Aim

Aim: to identify the risk factors for conversion of endoscopic submucosal dissection to abdominal surgery.

Patients and methods

Patients and methods: the prospective cohort study included 405 patients: 166 (40.9%) males and 239 (59.1%) females. The median age was 66 (59; 72) years old; the patients underwent endoscopic submucosal dissection of colorectal epithelial neoplasms.

Results

Results: the median size of the removed neoplasms was 3.0 (2.4; 4) cm, tumor was removed en bloc in 324/363 (89.2%) cases; and R0 resection margins were detected in 218/324 (67.3%) cases. Significant risk factors for conversion were: the tumor size ≥ 3.2 cm (OR 2.9, 95% CI 1.2–7.1, p = 0.017), lifting ≤ 3 mm (OR 41, 95% CI 15–105, p = 0.000002) and the tumor vascular pattern IIIa according Sano’s capillary pattern classification (OR 4.0, 95% CI 1.3–11.9, p = 0.013).

Conclusion

Conclusion: endoscopic submucosal dissection is a safe way to remove colorectal neoplasms. However, the presence of conversion risk factors can influence the outcome of endoscopic treatment.

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The authors declare that there are no conflicts of interest present.