[Clinical analysis of laparoscopic remedial surgery for endoscopic lesions in early colorectal cancer].

Objective: To investigate the safety and feasibility of laparoscopic remedial surgery in patients who didn't reach the cure criterion of early colorectal cancer after endoscopic resection. Methods: The clinical and follow-up data of 12 patients who didn't reach the cure criterion of early colorectal cancer and then underwent endoscopic resection was collected. The clinicalpathological features and remedial indications were analyzed to evaluate the effects of laparoscopic remedial surgery. Results: The average number of lymph nodes in the lymph node dissection was 15 during remedial surgery, and 3 of them had lymph node metastasis. Among the 3 patients with residual cancer, two cases were poorly differentiated, 1 case was moderately differentiated, 1 case was positive for basal margin, and 1 case had vascular invasion. No lymph node metastasis occurred in the 9 patients who had no residual cancer. Among these, 8 cases were moderately differentiated, 1 case was poorly differentiated and 2 cases had positive basal margin. The average follow-up duration was 40 months and all 12 patients were in a state of survival at the last follow-up. During the follow-up of the 3 patients with residual cancer, 1 patient received adjuvant chemotherapy with unknown prognosis; 1 patient received postoperative adjuvant radiochemotherapy, and lung metastasis occurred; 1 patient did not receive any treatment after surgery and survived for 33 months. Conclusions: Laparoscopic remedial surgery is a safe and feasible remedy for patients who didn't reach the cure criterion of early colorectal cancer after endoscopic resection. However, the choice of remedial strategy for colorectal carcinoma needs further investigation for patients with no vascular invasion, high degree of differentiation, and negative basal margin.目的： 探讨早期结直肠癌患者内镜下病损切除后未达治愈标准的补救方式，以及行腹腔镜补救手术的安全性和可行性。 方法： 收集12例早期结直肠癌内镜下病损切除治疗后未达治愈标准再行腹腔镜补救手术患者的临床和随访资料，分析其临床病理特征和补救手术指征，评价腹腔镜补救手术的效果。 结果： 12例患者腹腔镜补救手术平均清扫淋巴结15枚。其中3例术后病理显示有癌残留，且均发生淋巴结转移；2例为低分化，1例为中分化；1例基底切缘阳性；1例发生脉管侵犯。9例未发生癌残留的患者无淋巴结转移；8例为中分化，1例为低分化；2例基底切缘阳性。平均随访40个月，12例患者末次随访时均生存。3例腹腔镜补救手术后病理显示癌残留的患者中，1例术后辅助化疗，预后不详；1例术后辅助放化疗，发生肺转移；1例术后未接受其他治疗，生存33个月。 结论： 腹腔镜补救手术是内镜下病损切除后未达治愈标准结直肠癌患者安全可行的补救方式，但对于无脉管侵犯、肿瘤分化程度较高和基底切缘阴性的结直肠癌患者，补救策略的选择有待进一步探究。.