Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press14010.17650/2220-3478-2015-5-3-25-32ORIGINAL REPORTSОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯArgon plasma coagulation in coloproctology: clinical experience with and prospects for the techniqueАргоноплазменная коагуляция в колопроктологии: клинический опыт и перспективы методаDesyatovE. N.ДесятовЕ. Н.
Russian Federation
desyatov@inbox.ruAlievF. Sh.АлиевФ. Ш.
Russian Federation
Meditsinskiy Gorod (Medical Town) Multidisciplinary Clinical Medical CenterГАУЗ ТО «Многопрофильный клинический медицинский центр «Медицинский Город»32 Barnaulskaya St., Tyumen, 625041, RussiaРоссия, 625041, Тюмень, ул. Барнаульская, 32Tyumen State Medical University of the Ministry of Health of RussiaГБОУ ВПО «Тюменский государственный медицинский университет»54 Odesskaya St., Tyumen, 625023, RussiaРоссия, 625023, Тюмень, ул. Одесская, 54081020155325320810201508102015Copyright ©; 2015, ABV-pressCopyright ©; 2015, АБВ-пресс2015ABV-pressАБВ-прессhttps://onco-surgery.info/jour/about/editorialPolicieshttps://onco-surgery.info/jour/article/view/140

Background. Rectal laterally spreading tumors (LSTs) are macroscopically divided into granular (LST-G) and non-granular (LST-NG). LST-Gs have in turn two types: homogeneous and nodular mixed.

Subjects and methods. The retrospective study analyzed the data of 20 patients (11 men and 9 women) in whom homogenous LSTs were removed by argon plasma coagulation (APC). The patients» mean age was 65.8 ± 6 years. Therapeutic effectiveness was evaluated by Ki-67 proliferation index and the frequency of complications and recurrences.

Results. The average size of removed homogeneous LST-Gs was 12.3 ± 3.8 cm2. The average number of APC sessions to achieve a LST-G reduction was 4.4 ± 0.9. Three days before APC, Ki-67 in the neoplasia biopsy specimens amounted to as much as 67.8 ± 4.4 % on average; it reduced to an average of 33.0 ± 3.0 % at 14 days of APC initiation, 16.5 ± 1.8 and 4.2 ± 0.4 % after 21 and 180 days, respectively.

Discussion. Inability to receive complete histological data on removed LST-Gs is a main pitfall in APC.

Conclusion. Stepwise tumor APC may be the method of choice in elderly and senile patients with a family history of comorbidity. APC can precisely remove LSTs along the boundary of the dentate line. This technique requires no single-use tools.

rectal laterally spreading tumorsmucosasubmucosagranular laterally spreading tumorshomogeneous granular laterally spreading tumorsendoscopic mucosal resectionendoscopic mucosal resection with submucosal dissectionargon plasma coagulationtransanal excisiontransanal endoscopic microsurgeryстелющиеся образования прямой кишкислизистая оболочкаподслизистый слойгранулированные стелющиеся образованиягранулированные стелющиеся образования однородного типаэндоскопическая резекция слизистой оболочкиэндоскопическая резекция слизистой оболочки с диссекцией в подслизистом слоеаргоноплазменная коагуляциятрансанальное иссечениетрансанальная эндоскопическая микрохирургия1. Muto T., Kamiya J., Sawada T. et al. Small “flat” adenoma of the large bowel with special reference to its clinicopathological feature. Dis Colon Rectum 1985;28:857–61.Muto T., Kamiya J., Sawada T. et al. Small “flat” adenoma of the large bowel with special reference to its clinicopathological feature. Dis Colon Rectum 1985;28:857–61.2. Hurlstone D., Cross S., Adam I. et al. A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the UK. Am J Gastroenterol 2003;98:2814–9.Hurlstone D., Cross S., Adam I. et al. A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the UK. Am J Gastroenterol 2003;98:2814–9.3. Saitoh Y., Waxman I., West A. B. et al. Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology 2001;120:1657–65.Saitoh Y., Waxman I., West A. B. et al. Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology 2001;120:1657–65.4. Kudo S., Kashida H., Tamura T. et al. Colonoscopic diagnosis and management of non-polypoid early colorectal cancer. World J Surg 2000;24:1081–90.Kudo S., Kashida H., Tamura T. et al. Colonoscopic diagnosis and management of non-polypoid early colorectal cancer. World J Surg 2000;24:1081–90.5. Soetikno R. M., Kaltenbach T., Rouse R. V. et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 2008;299(9):1027–35.Soetikno R. M., Kaltenbach T., Rouse R. V. et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 2008;299(9):1027–35.6. Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993;25(7):455–61.Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993;25(7):455–61.7. Oka S., Tanaka S., Kanao H. et al. Therapeutic strategy for colorectal laterally spreading tumor. Dig Endosc 2009;21(1):43–6.Oka S., Tanaka S., Kanao H. et al. Therapeutic strategy for colorectal laterally spreading tumor. Dig Endosc 2009;21(1):43–6.8. Uraoka T., Saito Y., Matsuda T. et al. Endoscopic indications for EMR of LST in the colorectum. Gut 2006;55:1592–7.Uraoka T., Saito Y., Matsuda T. et al. Endoscopic indications for EMR of LST in the colorectum. Gut 2006;55:1592–7.9. Waxman I., Saitoh Y. Clinical outcome of endoscopic mucosal resection for superficial GI lesions and the role of highfrequency US probe sonography in an American population. Gastrointest Endosc 2000;52:322–7.Waxman I., Saitoh Y. Clinical outcome of endoscopic mucosal resection for superficial GI lesions and the role of highfrequency US probe sonography in an American population. Gastrointest Endosc 2000;52:322–7.10. Hurlstone D. P., Brown S., Cross S. S. et al. Endoscopic ultrasound miniprobe staging of colorectal cancer: can management be modified? Endoscopy 2005;37(8):710–4.Hurlstone D. P., Brown S., Cross S. S. et al. Endoscopic ultrasound miniprobe staging of colorectal cancer: can management be modified? Endoscopy 2005;37(8):710–4.11. Harada N., Hamada S., Kubo H. et al. Preoperative evaluation of submucosal invasive colorectal cancer using a 15-MHz ultrasound miniprobe. Endoscopy 2001;33(3):237–40.Harada N., Hamada S., Kubo H. et al. Preoperative evaluation of submucosal invasive colorectal cancer using a 15-MHz ultrasound miniprobe. Endoscopy 2001;33(3):237–40.12. Repici A., Pagano N., Rando G. et al. A prospective, single center study of endoscopic submucosal dissection of rectal LST lesions larger than 3 cm by using an innovative concept of injecting and cutting: the water-jet hybrid-knife (ESD-H). Gastrointest Endosc 2011;73(4):2011.Repici A., Pagano N., Rando G. et al. A prospective, single center study of endoscopic submucosal dissection of rectal LST lesions larger than 3 cm by using an innovative concept of injecting and cutting: the water-jet hybrid-knife (ESD-H). Gastrointest Endosc 2011;73(4):2011.13. Nakajima T., Tanaka S., Saito Y. et al. Prospective multicenter study on endoscopic treatment of large early colorectal neoplasia conducted by Colorectal Endoscopic Resection Standardization Implementation Working Group of Japanese Society for Cancer of the Colon and Rectum. Abstract presented at the UEGW 2011, Stockholm, Sweden. Endoscopy 2011;43(Suppl 1): A1.Nakajima T., Tanaka S., Saito Y. et al. Prospective multicenter study on endoscopic treatment of large early colorectal neoplasia conducted by Colorectal Endoscopic Resection Standardization Implementation Working Group of Japanese Society for Cancer of the Colon and Rectum. Abstract presented at the UEGW 2011, Stockholm, Sweden. Endoscopy 2011;43(Suppl 1): A1.14. Агапов М. Ю., Таран Н. А., Рыжков Е. Ф., Барсуков А. С. Эндоскопическая резекция слизистой оболочки при неполиповидных образованиях толстой кишки. Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2008;18(4):77–81.Агапов М. Ю., Таран Н. А., Рыжков Е. Ф., Барсуков А. С. Эндоскопическая резекция слизистой оболочки при неполиповидных образованиях толстой кишки. Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2008;18(4):77–81.[Agapov M. Yu., Taran N. A., Ryzhkov E. F., Barsukov A. S. Endoscopic resection of the mucous membrane in cases of nonpolypoid lesions of the colon. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology 2008;18(4): 77–81. (In Russ.)].15. Hurlstone D. P., Sanders D. S., Cross S. S. et al. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut 2004;53:1334–9.Hurlstone D. P., Sanders D. S., Cross S. S. et al. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut 2004;53:1334–9.16. Antillon M. R., Bartalos C. R., Miller M. L. et al. En bloc endoscopic submucosal dissection f a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: xpanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc 2008;67:332–7.Antillon M. R., Bartalos C. R., Miller M. L. et al. En bloc endoscopic submucosal dissection f a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: xpanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc 2008;67:332–7.17. Stroppa I., Milito G., Lionetti R. et al. Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal esection. BMC Gastroenterol 2010;10:135.Stroppa I., Milito G., Lionetti R. et al. Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal esection. BMC Gastroenterol 2010;10:135.18. Tanaka S., Oka S., Kaneko I. et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 2007;66(1):100–7.Tanaka S., Oka S., Kaneko I. et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 2007;66(1):100–7.19. Parks A. G. The place of local excision in the treatment of carcinoma of the rectum. An gastroenterol et hepatol 1977;7:771–5.Parks A. G. The place of local excision in the treatment of carcinoma of the rectum. An gastroenterol et hepatol 1977;7:771–5.20. Филон А. Ф., Пересада И. В., Челноков М. В. Выбор метода лечения крупных аденом прямой кишки. Колопроктология 2011;2:13–17. [Filon A. F., Peresada I. V., Chelnokov M. V. Selection of method of treatment of major adenomas of the rectum. Koloproktologiya =Coloproctology 2011;2:13–17. (In Russ.)].Филон А. Ф., Пересада И. В., Челноков М. В. Выбор метода лечения крупных аденом прямой кишки. Колопроктология 2011;2:13–17. [Filon A. F., Peresada I. V., Chelnokov M. V. Selection of method of treatment of major adenomas of the rectum. Koloproktologiya =Coloproctology 2011;2:13–17. (In Russ.)].21. Мансуров Ю. В. Трансанальное эндохирургическое удаление ворсинчатых опухолей прямой кишки с использованием стабильного расширяющегося конусовидного операционного доступа. Эндоскопическая хирургия 2010;3:40–5. [Mansurov Yu. V. Transanal endosurgical removal of villous tumors in the rectum with the use of stable expanding tapered operative approach. Endoskopicheskaya khirurgiya = Endoscopic Surgery 2010;3:40–5. (In Russ.)].Мансуров Ю. В. Трансанальное эндохирургическое удаление ворсинчатых опухолей прямой кишки с использованием стабильного расширяющегося конусовидного операционного доступа. Эндоскопическая хирургия 2010;3:40–5. [Mansurov Yu. V. Transanal endosurgical removal of villous tumors in the rectum with the use of stable expanding tapered operative approach. Endoskopicheskaya khirurgiya = Endoscopic Surgery 2010;3:40–5. (In Russ.)].22. Васильев С. В., Попов Д. Е., Черниковский И. Л., Григорян В. В. Использование методики трансанальной эндоскопической микрохирургии в лечении новообразований прямой кишки. Вестник хирургии им. И. И. Грекова 2007;5:65–8. [Vasiliyev S. V., Popov D. E., Chernikovskiy I. L., Grigoryan V. V. Use of the methodology of transanal endoscopic microsurgery in treatment of neoplasm, s of the rectum. Vestnik hirurgii im. I. I. Grekova = I. I. Grekov Surgery Herald 2007;5:65–8. (In Russ.)].Васильев С. В., Попов Д. Е., Черниковский И. Л., Григорян В. В. Использование методики трансанальной эндоскопической микрохирургии в лечении новообразований прямой кишки. Вестник хирургии им. И. И. Грекова 2007;5:65–8. [Vasiliyev S. V., Popov D. E., Chernikovskiy I. L., Grigoryan V. V. Use of the methodology of transanal endoscopic microsurgery in treatment of neoplasm, s of the rectum. Vestnik hirurgii im. I. I. Grekova = I. I. Grekov Surgery Herald 2007;5:65–8. (In Russ.)].23. von Flüe M., Harder F. Transanal endoscopic microsurgery (TEM): indications andlimitations. Schweiz Med Wochenschr 1994;124(41):1800–6.von Flüe M., Harder F. Transanal endoscopic microsurgery (TEM): indications andlimitations. Schweiz Med Wochenschr 1994;124(41):1800–6.24. Buess G., Hutterer F., Theiss J. et al. A system for a transanal endoscopic rectum operation. Chirurg 1984;55:677–80.Buess G., Hutterer F., Theiss J. et al. A system for a transanal endoscopic rectum operation. Chirurg 1984;55:677–80.25. Воробьев Г. И., Одарюк Т. С., Царьков П. В. и др. Трансанальная микрохирургия в лечении опухолей прямой кишки. Российский онкологический журнал 2002;4:20–5. [Vorobiyev G. I., Odaryuk T. S., Tsarkov P. V. et al. Transanal miscrosurgery in treatment of tumors of the rectum. Rossiyskiy onkologicheskiy zhurnal = Russian Journal of Oncology 2002;4:20–5. (In Russ.)].Воробьев Г. И., Одарюк Т. С., Царьков П. В. и др. Трансанальная микрохирургия в лечении опухолей прямой кишки. Российский онкологический журнал 2002;4:20–5. [Vorobiyev G. I., Odaryuk T. S., Tsarkov P. V. et al. Transanal miscrosurgery in treatment of tumors of the rectum. Rossiyskiy onkologicheskiy zhurnal = Russian Journal of Oncology 2002;4:20–5. (In Russ.)].26. Grund K. E., Storek D., Farin G. Endoscopic argon plasma coagulation (APC). First clinical experiences in flexible endoscopy. Endosc Surg Allied Technol 1994;2(1):42–6.Grund K. E., Storek D., Farin G. Endoscopic argon plasma coagulation (APC). First clinical experiences in flexible endoscopy. Endosc Surg Allied Technol 1994;2(1):42–6.27. Brooker J. C., Saunders B. P., Shah S. G. et al. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc 2002;55(3):371–5.Brooker J. C., Saunders B. P., Shah S. G. et al. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc 2002;55(3):371–5.28. Garcia A., Núñez O., González-Asanza C. et al. Safety and efficacy of argon plasma coagulator ablation therapy for flat colorectal adenomas. Rev Esp Enferm Dig 2004;96(5):315–21.Garcia A., Núñez O., González-Asanza C. et al. Safety and efficacy of argon plasma coagulator ablation therapy for flat colorectal adenomas. Rev Esp Enferm Dig 2004;96(5):315–21.29. Neneman B., Gasiorowska A., Malecka- Panas E. The efficacy and safety of argon plasma coagulation (APC) in the management of polyp remnants in stomach and colon. Adv Med SciNeneman B., Gasiorowska A., Malecka- Panas E. The efficacy and safety of argon plasma coagulation (APC) in the management of polyp remnants in stomach and colon. Adv Med Sci2006;51:88–93.;51:88–93.30. Regula J., Wronska E., Polkowski M. et al. Argon plasma coagulation (APC) after piecemeal polypectomy for sessile colorectal adenomas: long term follow-up study. Endoscopy 2003;35(3):212–8.Regula J., Wronska E., Polkowski M. et al. Argon plasma coagulation (APC) after piecemeal polypectomy for sessile colorectal adenomas: long term follow-up study. Endoscopy 2003;35(3):212–8.31. Wahab P. J., Mulder C. J., den Hartog G., Thies J. E. Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences. Endoscopy 1997;29(3):176–81.Wahab P. J., Mulder C. J., den Hartog G., Thies J. E. Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences. Endoscopy 1997;29(3):176–81.32. Zlatanic J., Waye J. D., Kim P. S. et al. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal polypectomy. Gastrointest Endosc 1999;49(6):731–5.Zlatanic J., Waye J. D., Kim P. S. et al. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal polypectomy. Gastrointest Endosc 1999;49(6):731–5.33. Enestvedt B. K., Tofani C., Laine L. A. et al. 4-Liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis. Clin Gastroenterol Hepatol 2012;10(11):1225–31.Enestvedt B. K., Tofani C., Laine L. A. et al. 4-Liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis. Clin Gastroenterol Hepatol 2012;10(11):1225–31.