Clinical significance and surgical management strategy for colorectal high-grade intraepithelial neoplasia / 国际外科学杂志

ABSTRACT

Objective To analyze the clinical and pathological characteristics and its surgical management strategy for colorectal high-grade intraepithelial neoplasia (HGIN).Methods Eighty-two cases with colorectal tumors diagnosed as colorectal HGIN based on colonoscopic biopsy between January 2005 and December 2012 were enrolled in the study.The clinicopathological data of all the patients was collected and analyzed.Of the 82 cases,71 cases had radical colorectal surgery,1 cases had Miles operation after previous transanal excisions,3 had transanal local excisions,8 cases had palliative surgery.The surgical specimens were all examined pathologically and compared with the preoperative diagnosis of colonoscopic biopsy of all the patients.Results Three cases (3.7％) were pathologically diagnosed as high-grade intraepithelial neoplasia,their average diameter was 1.5 cm.The other 79 (96.3％) cases were diagnosed as adenocarcinoma,with an average diameter of 4.7 cm.The difference in tumor size was statistically significant (P ＜ 0.01).Comparison of pre-and post-operative specimens showed poor consistency,the Kappa value was O.104.Significant analysis showed a correlation between cancerous change to tumor size and depth of invasion.In the 79 cases confirmed as adenocarcinoma,liver metastasis occurred in 8 cases,regional lymph nodes metastasis in 31 cases (39.2％).Of the 33 cases with rectal tumors,30 cases (90.9％) were pathologically diagnosed as adenocarcinoma after operation.Conclusions Much attention should be payed to the pathological diagnosis in colorectal intraepithelial neoplasia,especially in the HGIN.We have found that of the cases first diagnosed as HGIN,approximately 96.3％ already have invasion adenocarcinoma.Most cases had reginonal lymph nodes metastasis.Liver metastasis had been occurred.thus active surgical measures should be taken.If the location of the tumor was not involved to anal sphincter,or cases with tumors larger than 3 cm was diagnosed,in highly suspected cases with malignant potiential,radical surgery is recommended.For tumors located at the lower rectum,the final decision should be made only after repeated endoscopic or transanal biopsy.