Clinical Study Of Endoscopic Submucosal Dissection In The Treatment Of Early Colorectal Cancer And Precancerous Lesions

Objective: To compare the efficacy and incidence of postoperative complications of endoscopic submucosal dissection in the treatment of early colorectal cancer and precancerous lesions in different sites and to explore the risk factors of postoperative complications of endoscopic submucosal dissection.Methods:1.The clinical data of 160 patients who were treated by colorectal endoscopic submucosal dissection in our hospital from November 2012 to December 2020 and were pathologically confirmed as early cancer and precancerous lesions was collected.2.The patients were divided into the left-sided colon group,the right-sided colon group and the rectum group according to the site of lesions.Chi-square test and one-way analysis of variance were used to compare the clinical and pathological features,the therapeutic effect and the incidence of postoperative complications of the three groups.3.The patients were divided into the bleeding group and the non-bleeding group according to the occurrence of delayed bleeding after colorectal endoscopic submucosal dissection.And they were divided into the perforation group and the non-perforation group according to the occurrence of delayed perforation.Univariate and multivariate analyses were used to explore the risk factors of delayed bleeding and delayed perforation after colorectal endoscopic submucosal dissection.Results:1.The pathological type and the curative resection rate were statistically significant different in three groups(p<0.05),while there were no statistically significant differences in sex,age,lesion size,lesion number,en bloc resection rate,incidence of delayed bleeding and delayed perforation(p>0.05).The pathological type were further compared in pairs among the three groups,and we found that there were no statistically significant differences(p>0.0167).The curative resection rate were further compared in pairs among the three groups,and we found that there were no statistically significant differences(p>0.0167).2.Among 160 patients,delayed bleeding after colorectal endoscopic submucosal dissection occurred in 9 patients(5.6%)and delayed perforation in 4patients(2.5%).Univariate analysis revealed that hypertension(p=0.042)and the pathological type(p=0.015)were significantly associated with delayed bleeding after colorectal endoscopic submucosal dissection.Multivariate analysis showed that hypertension(p=0.039,OR=4.462,95%CI: 1.082-6.748)and the pathological type(p=0.023,OR=2.793,95%CI: 1.156-7.433)were independent risk factors for delayed bleeding after colorectal endoscopic submucosal dissection.Patients with hypertension had a higher risk of delayed bleeding than those without hypertension.Among the pathological types,the risk of delayed bleeding of adenoma,low-grade intraepithelial neoplasia,high-grade intraepithelial neoplasia,and early carcinoma increased successively.Univariate analysis showed that the pathological type was related to delayed perforation after colorectal endoscopic submucosal dissection(p<0.001).Next,patients were divided into early colorectal cancer group and precancerous lesions group according to the pathological type.We found that the incidence of delayed perforation is higher in patients with early cancer(p=0.001).Conclusion:1.Hypertension and the pathological type are independent risk factors for delayed bleeding after colorectal endoscopic submucosal dissection.Patients with early cancer have a higher risk of delayed bleeding.2.Patients with early cancer have a higher risk of delayed perforation than those with precancerous lesions.