Analysis Of Clinicopathological Features And Integrated Medicine Treatment Strategy Of Colorectal Laterally Spreading Tumors

AIMSA single-center retrospective analysis was performed on the data of colorectal laterally spread-ing tumors patients who met the inclusion criteria in the digestive endoscope center of Jiangsu Provincial Hospital of Chinese Medicine.First,the clinical and pathological features of colorec-tal laterally spreading tumors were summarized through clinical data,endoscopic findings and postoperative pathological features.Second,analyze the advantages and disadvantages of each endoscopic treatment method and the endoscopic characteristics,and provide follow-up recom-mendations based on postoperative follow-up data.Finally,the application of Chinese medicine in colorectal laterally spreading tumors treatment was explored.METHODSThe clinical and pathological data of patients with colorectal laterally spreading tumors treated with endoscopy at Jiangsu Provincial Hospital of Chinese Medicine from January 1,2013 to Oc-tober 1,2018 were analyzed.The study data included the patient’s hospital records,colonoscopy results,surgical reports,and postoperative pathological dataRESULTS1.Analysis of clinicopathological characteristics of colorectal laterally spreading tumorsA total of 369 patients were included in the study,including 188 males and 181 females,with an average age of 63.23±11.93 years old.Of these,30 patients underwent endoscopic treatment in outpatient and 339 patients underwent endoscopic treatment in hospital.A total of 392 lesions were detected in all patients,of which 349 patients were single lesions and 20 patients were mul-tiple lesions.There were 15 cases of circumferentia lesions and 377 cases of non-circumferentia lesions.The average short diameter of the lesion was 1.95±0.93cm,the average long diameter was 2.23±1.20cm,and the average area was 4.21±5.56cm 2.By lesion location,49 cases were ileocecal lesions,96 were ascending colon lesions,42 were hepatic curvature lesions,39 were transverse colon lesions,9 were spleen curvature lesions,26 were descending colon lesions,62 were sigmoid colon lesions,69 were rectal lesions,and 3 were anastomotic lesions.According to endoscopic morphological classification,there were 218 LST-G lesions,including 96 LST-GH lesions and 122 LST-GM lesions;174 LST-NG lesions,including 158 NG-F lesions,and NG-PD lesions 16 cases.According to the postoperative pathological results,there were 281 adenoma-type lesions in 392 cases,including 162 cases of tubular adenomas,0 cases of villous adenomas,119 cases of tubulovillous adenomas.There were 94 cases of serrated lesions,including 67 cases of hyperplastic polyp,12 cases of sessile serrated polyp,4 cases of sessile serrated adenoma,and 11 cases of traditional serrated adenomas.There were 17 cases of adenocarcinoma.According to different risk levels,289 cases were in the low-risk pathology group and 103 cases were in the high-risk pathology group.There are statistical differences in the types of lesions(short diameter,long diameter,area),lesion range,lesion location,and pathological types under different endo-scopic types.There were statistical differences between the low-risk pathological group and the high-risk pathological group in terms of lesion size(short diameter,long diameter,area),lesion range,circumferentia lesions,lesion sites,and endoscopic typing.2.Endoscopic treatment strategies for colorectal laterally spreading tumorsAmong 392 lesions,89 lesions were treated with EMR,3 lesions were treated with EPMR5 221 lesions were treated with ESD,53 lesions were treated with Pre-cut-EMR,6 lesions were treated with PCM,and 20 lesions were treated with PESTD.The en bloc resection rate of all lesions was 99.23%.There were no lesions with positive horizontal resection margins.8.67%of the lesions showed positive vertical resection margins.The complete resection rate of all lesions was 90.56%,and the curative resection rate was 88.27%.The average operation time was 21.30±35.82min and the average resection speed was 0.38±0.36cm 2/min.The complication rate of all patients was 5.15%,of which the incidence of bleeding was 1.90%,the incidence of perforation was 1.36%,and the incidence of infection was 1.90%.The average total length of hospital stay was 11.65±9.14 days,and the length of postoperative stay was 6.49±3.62 days.The lesions removed by different surgical methods have statistical differences in lesion size(short diameter,long diameter,area),lesion range,circumferentia lesions,operation duration,resection speed,en bloc resection rate,vertical resection margin,and complete resection rate.3.Follow-up analysis of colorectal lateral spreading tumors after endoscopic treatmentA total of 369 patients were lost to follow-up,and 207 patients were followed up effec-tively.The follow-up rate was 56.10%.Lost follow-up patients/lesions and non-lost follow-up patients/lesions by gender,age,number of lesions,size of lesions(short diameter,long diame-ter,area),circumferentia lesions,size range,location,endoscopic classification.There were no statistical differences in the en bloc resection rate,horizontal resection margin,vertical resection margin,complete resection rate,and curative resection rate.There were statistical differences in patient came from,surgical methods,and pathological results.In terms of patient come from,the rate of lost follow-up of outpatients(83.33%)was higher than that of inpatients(40.41%).In terms of surgical methods,the rates of lost follow-up and non-followed by different surgical methods are statistically different;in general,the lost follow-up rate of EMR and EPMR is greater than that of ESD,Pre-cut-EMR,PCM,and PESTD.The rate of lost follow-up is less than the rate of no follow－up;specific to the comparison of various surgical methods,the lost follow-up rate(58.43%)for EMR surgery is higher,while the Iost follow-up rate(20.00%)for patients undergoing PESTD surgery is lower,the difference is It is statistically significant,and there is no significant differ-ence in the lost follow-up rate and follow-up rate for the other procedures.The follow-up time and results of the patients were analyzed.The results showed that the shortest follow-up interval was 40 days,the longest was 2000 days,and the average follow-up interval was 328.5 1±284.89 days.The results of the first review showed that there were 151 patients with no recurrence,ac-counting for 72.95%;51 patients with low-risk recurrence,accounting for 24.64%;5 patients with high-risk recurrence,accounting for 2.42%.High-risk recurrence and low-risk recurrence patients were defined as risk recurrence and univariate analysis was performed.The results showed gender,number of lesions,patient come from,lesion size(short diameter,long diameter,area),circum-ferentia lesions,lesion size range,lesion location,and en bloc resection rate have no statistically significant difference,so it is not considered a risk factor for risky recurrence.In terms of endo-scopic classification,the proportion of patients with LST-GM risk of recurrence is higher than that of patients without recurrence.In terms of age,the average age of patients with risk of relapse is larger than that of patients without recurrence,and the difference is statistically significant.In terms of surgical methods,the risk recurrence rate of PESTD surgery alone(62.50%)is higher than the risk recurrence rate of non-PESTD surgery(36.27%).There was no significant difference in the proportion of patients with risky recurrence and non-recurrence in the other surgical methods.The positive rate of vertical resection margin,complete resection rate,and curative resection was higher in patients with risk recurrence than in non-recurrence patients,while the rate of complete resection and curative resection was lower.In terms of postoperative pathological results,the pro-portion of postoperative pathological patients with high-risk pathology was higher in patients with risky recurrence.There were 5 patients with recurrence of LST in 207 patients,with a recurrence rate of 2.42%.4.Analysis of Chinese medicine treatment strategies for colorectal lateral spreading tumorsA total of 175 patients were selected for analysis after June 1,2016.All patients included 40 cases in the Chinese medicine group and 135 cases in the control group.All patients included 40 cases in the traditional Chinese medicine group and 135 cases in the control group.All patients were single lesion.Most baseline data(gender,age,patient come frome,circumferentia lesions,lesion size range,location,endoscopic classification,surgical method,en bloc resection rate,ver-tical resection margin,complete resection rate,curative resection rate,postoperative pathological results)were not statistically different,but there were statistical differences in lesion size(short diameter,long diameter,area).The lesion area of the patients in the Chinese medicine group was larger than that in the control group.In terms of lost follow-up,10 cases were lost in the Chinese medicine group,with a loss rate of 25.00%,and 66 cases in the control group were lost,with a loss rate of48.89%.After excluding all lost follow-up patients,the baseline data of the two groups were re-analyzed,and the results showed that there was no significant statistical difference in the baseline data except for the lesion range.Further statistical analysis of the lesion range shows that there is a statistical difference in the proportion of the 2cm～3cm lesion between the Chinese medicine group and the control group.Statistical analysis of the risk recurrence of the lesions in the two groups showed that the difference in the risk recurrence ratio between the two groups was statistically significant.The risk recurrence rate of the Chinese medicine group(16.67%)was lower than that of the control group(43.48%).Considering that there are some differences in base-line data between the two groups of patients,the bias was treated by propensity matching analysis There were 30 patients in the Chinese medicine group and 60 patients in the control group af-ter matching.The matching ratio was 1:2.There was no significant statistical difference in the baseline data of the two groups after matching.Analysis of the risk recurrence showed that the risk recurrence rate of the Chinese medicine group was 16.67%,and the risk recurrence rate of the control group was 38.33%.The difference between the two groups was statistically signifi-cant.The risk recurrence rate of the Chinese medicine group was lower than that of the control group.The frequency of use of 14 Chinese medicines is more than 25%,including 4 types of qi-enhancing drugs,3 types of qi-regulating drugs,2 types of hemostatic drugs,and one type of purga-tive medicine,heat-clearing medicine,anti-cold medicine,astringent medicine,and heat-clearing phlegm medicine.The top five drugs used frequently were Atractylodes macrocephala(80.00%),Poria(75.00%),Chenpi(65,00%),Zhigancao(62.50%),Coptis chinensis(47.50%).Select Chinese medicines(16 species in total)that have been applied more than 25%(included)for systematic cluster analysis and set the number of classifications to 3 for drug classification.The classification results are as follows:① Codonopsis,Astragalus,Xiangfu,Bai And,jellyfish,woody fragrant,Evodia rutaecarpa,Dimu charcoal,Fritillaria frondosa,Wumei,Wulingzhi;②Chenpi,Zhigancao,Baizhu,Poria;③CoptisCONCLUSIONS1.Colorectal laterally spreading tumor has certain clinicopathological characteristics.There are some differences in the clinical and pathological data of different types of LST under endoscope.A variety of clinical features,including endoscopic typing,such as the size of the lesion(short diameter,long diameter,and area of the lesion),the extent of the lesion,circumferentia lesions,and the location of the lesion have some significance in predicting risky LST.Therefore,adequate endoscopic evaluation of LST patients and collection and evaluation of clinical data are of great significance for the selection of treatment options.2.Different endoscopic treatment methods have different indications.In addition to consid-ering the characteristics of patients and lesions,the technical strength of the endoscopic center is also an important reference for selecting a treatment method.3.The follow-up of endoscopic treatment of colorectal LST needs to be fully evaluated ac-cording to the clinicopathological results of the patient,especially for high-risk patients4.The application of Chinese medicine can reduce the risk of recurrence of colorectal LST The main treatment ideas are to nourish qi and spleen,and to reconcile cold and heat.