E.V. Gorbachev1, 2, E.D. Fedorov1, 2, S.G. Shapovaliants1, 2, S.A. Budzinskiy1, 2, A.S. Melnikova1
1Pirogov Russian National Research Medical University, Moscow
2City Clinical Hospital No. 31 named after Acad. G.M. Savelyeva, Moscow
Gorbachev E.V. — PhD (Medicine), Assistant Lecturer of the Department of Hospital Surgery No. 2, endoscopist
42 lobachevskogo St., 119415 Moscow, Russian Federation, tel.: +7-926-185-94-33, e-mail: doc.fenix@mail.ru, , https://orcid.org/0000-0001-7588-1031
Absrtact. To evaluate the results of endoscopic removal of large epithelial neoplasms (EN) on a wide base in the colon, depending on the degree of subcutaneous fibrosis; to determine the prognostic factors of the treatment success.
Material and methods. The study included 47 patients who underwent endoscopic removal of 54 lesions in 2023. The patients were divided into groups with or without fibrosis; a logistic regression analysis was performed to identify the prognostic factors of endoscopic treatment. We also analyzed subgroups for the degree of fibrosis and its correlation to the results of surgical treatment of the colon epithelial neoplasms.
Results. The overall incidence of fibrosis was 72.2% (mild — 33.3%, severe — 38.9%). There were no significant differences in average age, sex ratio, and concomitant pathology between the groups with (F) and without (F0) fibrosis. The EN location in the cecum dome and in the ascending intestine, including the hepatic bend, was more common in the fibrosis group (p < 0.001). Macroscopic types of LST-G tumors, including LST-G-H and LST-G-M, were significantly more common in the fibrosis group (p < 0.001). The average EN size of more than 30 mm was larger in the fibrosis group than in the F0 group (32.9 ± 9.45 mm versus 26.8 ± 8.8, p < 0.001). EN with fibrosis, which were located on/through the fold (y), significantly exceeded the number of such EOS in the F0 group (74.4 vs. 16.6% and 53.4 vs. 5.5%, p < 0.001, respectively). The fact of taking a biopsy from the EN before surgery also significantly increased the occurrence of fibrosis (F — 53.4% vs. F0 — 5.5%, p < 0.001).
Conclusion. We identified the prognostic factors of mild and severe fibrosis. Severe fibrosis significantly increases the risk of adverse events and reduces the possibility of removing EN as one fragment. These data should be taken into account when planning the removal of a large EN, including avoiding preoperative biopsy.
Key words: fibrosis, colorectal neoplasms, endoscopic mucosal resection, endoscopic submucosal dissection