引用文本：结直肠早癌全程管理指南制定工作组, 中华医学会外科学分会结直肠外科学组,广东省医院协会结直肠外科专业委员会. 早期结直肠癌全程管理指南（2025版）[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(2): 183-195.

作者：结直肠早癌全程管理指南制定工作组, 中华医学会外科学分会结直肠外科学组,广东省医院协会结直肠外科专业委员会

Authors：Working Group for the Development of Guidelines for the Full-course Management of Early Colorectal Cancer Chinese Society of Colorectal Surgery; Colorectal Surgery Group, Surgical Society of Chinese Medical Association; Colorectal Surgery Committee, Guangdong Provincial Hospital Association

摘要：

结直肠癌是中国高发恶性肿瘤之一，严重威胁居民生命健康。目前，我国较低的早期诊断率及早期治疗率，成为限制进一步改善结直肠癌患者预后的瓶颈。对早期结直肠癌进行标准化的全程管理，将促进中国早期结直肠癌诊治的同质性和规范性，提高结直肠癌患者的预后。在中华医学会外科学分会结直肠外科学组和广东省医院协会结直肠外科专业委员会牵头下，由中山大学附属第六医院组织涵盖外科学、内镜学、病理学、影像学、流行病学、循证医学、卫生经济学和卫生管理学等学科的专家成立指南制订专家组，基于世界卫生组织推荐的指南制定原则和方法，采取临床问卷调查及专家讨论的形式，经过证据检索和评价，制订了《早期结直肠癌全程管理指南（2025版）》。本指南涉及早期结直肠癌的筛查、诊断、治疗和随访等临床问题，并按照循证指南制订的方法整理出了33条相关的推荐意见，旨在构建覆盖全生命周期的规范化管理路径，提升早期结直肠癌的早诊率、治愈率和生活质量，助力“健康中国2030”战略目标。

关键词：结直肠肿瘤，早期；筛查；诊断；治疗；随访；全程管理

Abstract：

Colorectal cancer is one of the highly prevalent malignant tumors in China, posing a serious threat to the life and health of residents. Currently, the relatively low rates of early diagnosis and early treatment in China have become a bottleneck restricting the further improvement of the prognosis of colorectal cancer patients. The standardized whole-course management of early colorectal cancer will promote the homogeneity and standardization of the diagnosis and treatment of early colorectal cancer in China, and improve the prognosis of colorectal cancer patients. Led by the Colorectal Surgery Group of the Chinese Society of Surgery (Chinese Medical Association) and the Colorectal Surgery Committee of the Guangdong Provincial Hospital Association, the Sixth Affiliated Hospital of Sun Yat-sen University organized experts from disciplines including surgery, endoscopy, pathology, radiology, epidemiology, evidence-based medicine, health economics, and health management to establish an expert group for guideline development. Based on the guideline development principles and methods recommended by the World Health Organization (WHO), the group conducted clinical questionnaires and expert discussions, and after evidence retrieval and evaluation, formulated the Guidelines for the full-course management of early colorectal cancer (2025 version). This guideline covers clinical issues such as screening, diagnosis, treatment, and follow-up of early colorectal cancer. It also organizes 33 relevant recommendations in accordance with the methods for developing evidence-based guidelines. The purpose of this guideline is to establish a standardized management pathway covering the entire life cycle, improve the early diagnosis rate, cure rate, and quality of life for early colorectal cancer, and contribute to the strategic goal of "Healthy China 2030".

Key words：Colorectal neoplasms, early; Screening; Diagnosis; Treatment; Follow-up; Full-course management

参考文献 

[1] 国家癌症中心中国结直肠癌筛查与早诊早治指南制定专家组. 中国结直肠癌筛查与早诊早治指南(2020,北京)[J]. 中华肿瘤杂志,2021,43(1):16-38. DOI: 10.3760/cma.j.cn 112152-20210105-00010. 

[2] 国家卫生健康委员会. 结直肠癌筛查与早诊早治方案 (2024 年版)[J/OL]. 消化肿瘤杂志(电子版), 2024,16(4): 410-411. DOI: 10.3969/j.issn.1674-7402.2024.04.003. 

[3] 陈耀龙,杨克虎,王小钦,等.中国制订/修订临床诊疗指南的指导原则 (2022 版) [J]. 中华医学杂志 , 2022, 102(10): 697-703.DOI:10.3760/cma.j.cn112137-20211228-02911. 

[4] 蒋朱明,詹思延,贾晓巍,等.制订/修订«临床诊疗指南»的基 本方法及程序[J].中华医学杂志, 2016,96(4):250-253.DOI: 10.3760/cma.j.issn.0376-2491.2016.04.004. 

[5] Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010, 182(18): E839- E842. DOI: 10.1503/cmaj.090449. 

[6] Chen Y, Yang K, Marušic A, et al. A Reporting Tool for Practice Guidelines in Health Care: The RIGHT Statement [J]. Ann Intern Med, 2017,166(2):128-132. DOI: 10.7326/ M16-1565. 

[7] Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J]. BMJ, 2011,343:d5928. DOI: 10.1136/ bmj.d5928. 

[8] Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [EB/OL]. (2017-04-10)[2025-09- 01]. http://www. ohri. ca/programs/clinical_epidemiolo‐ gy/oxford.asp. 

[9] Whiting PF, Rutjes AWS, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies[J]. Ann Intern Med, 2011, 155(8): 529- 536. DOI: 10.7326/0003-4819-155-8-201110180-00009. 

[10] 陈耀龙,姚亮,Susan Norris,等.GRADE在系统评价中应用的 必要性及注意事项[J]. 中国循证医学杂志, 2013,13(12): 1401-1404.DOI:10.7507/1672-2531.20130240. 

[11] 上海市抗癌协会大肠癌专业委员会, 赵任. 结直肠癌早筛、早诊、早治上海方案(2023年版)[J].中国癌症杂志, 2024,34(1): 13-65. DOI: 10.19401/j.cnki.1007-3639.2024.01.002. 

[12] 中华医学会消化内镜学分会结直肠学组.中国结直肠癌及 癌前病变内镜诊治共识(2023,广州)[J].中华消化内镜杂志, 2023,40(7):505-520. DOI:10.3760/cma.j.cn321463-2023 0607-00229. 

[13] 中国临床肿瘤学会指南工作委员会 . 中国临床肿瘤学会 (CSCO)结直肠癌诊疗指南 2025 [M]. 北京:人民卫生出版 社, 2025. 

[14] Ba M, Sb E, Fl G. AJCC cancer staging manual eighth edition[M]. New York:Springer,2017. 

[15] Benson AB, Venook AP, Adam M, et al. NCCN Guidelines® Insights: Rectal Cancer, Version 3. 2024[J]. J Natl Compr Canc Netw, 2024, 22(6): 366-375. DOI: 10.6004/jnccn. 2024. 0041. 

[16] Rectum Japanese Society For Cancer. 大腸癌治療ガイドライン [M]. 日本东京: 金原出版株式会社, 2024. 

[17] Argilés G, Tabernero J, Labianca R, et al. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2020, 31(10): 1291-1305. DOI: 10.1016/j.annonc.2020.06.022. 

[18] Hofheinz RD, Fokas E, Benhaim L, et al. Localised rectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2025, 36(9): 1007-1024. DOI: 10.1016/j.annonc.2025.05.528. 

[19] Morino M, Risio M, Bach S, et al. Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference[J]. Surg Endosc, 2015, 29(4): 755-773. DOI: 10.1007/s00464-015-4067-3. 

[20] Wong MC, Ching JY, Ng S, et al. The discriminatory capability of existing scores to predict advanced colorectal neoplasia: a prospective colonoscopy study of 5, 899 screening participants[J]. Sci Rep, 2016, 6: 20080. DOI: 10.1038/srep20080. 

[21] Wong MCS, Lam TYT, Tsoi KKF, et al. A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects[J]. Gut, 2014,63(7):1130-1136. DOI: 10.1136/gutjnl-2013-305639. 

[22] Wang X, Zhang X, Liu J, et al. Establishment and validation of symptomatic patients colorectal screening score for predicting colorectal neoplasia risk[J]. J Dig Dis, 2023, 24(11):584-593. DOI: 10.1111/1751-2980.13235. 

[23] 杨梦园,袁之俊,袁瑛 . 中国遗传性大肠癌的筛查诊断研究 进展[J]. 科学通报, 2025,70(31):5233-5239. 

[24] Tian Y, Kharazmi E, Sundquist K, et al. Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study[J]. BMJ, 2019, 364: l803. DOI: 10.1136/bmj. l803. 

[25] 中国疾病预防控制中心慢性非传染性疾病预防控制中心 肿瘤防控专家组,吴静.中国社区居民结直肠癌筛查专家共识 [J]. 环境卫生学杂志 , 2024, 14(4): 273-285. DOI: 10.13421/j. cnki. hjwsxzz.2024.04.001. 

[26] Tian Y, Kharazmi E, Brenner H, et al. Calculating the starting age for screening in relatives of patients with colorectal cancer based on data from large nationwide data sets[J]. Gastroenterology, 2020,159(1):159-168. DOI: 10.1053/j.gastro.2020.03.063. 

[27] Dong X, Luo Z, Wu Z, et al. Risk-adapted starting age for personalized colorectal cancer screening: validated evidence from national population-based studies[J]. Clin Gastroenterol Hepatol, 2023, 21(3): 819-826. DOI: 10. 1016/j.cgh.2022.11.005. 

[28] Zaffaroni G, Mannucci A, Koskenvuo L, et al. Updated European guidelines for clinical management of familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), gastric adenocarcinoma, proximal polyposis of the stomach (GAPPS) and other rare adenomatous polyposis syndromes: a joint EHTG-ESCP revision[J]. Br J Surg, 2024, 111(5): znae070. DOI: 10.1093/bjs/znae070. 

[29] Kennedy RD, Potter DD, Moir CR, et al. The natural history of familial adenomatous polyposis syndrome: a 24 year review of a single center experience in screening, diagnosis, and outcomes[J]. J Pediatr Surg, 2014, 49(1): 82-86. DOI: 10.1016/j.jpedsurg.2013.09.033. 

[30] Kerr SE, Thomas CB, Thibodeau SN, et al. APC germline mutations in individuals being evaluated for familial adenomatous polyposis: a review of the Mayo Clinic experience with 1591 consecutive tests[J]. J Mol Diagn, 2013,15(1):31-43. DOI: 10.1016/j.jmoldx.2012. 07.005. 

[31] Thomas LE, Hurley JJ, Sanchez AA, et al. Duodenal adenomas and cancer in MUTYH-associated polyposis: an international cohort study[J]. Gastroenterology, 2021,160 (3):952-954. DOI: 10.1053/j.gastro.2020.10.038. 

[32] Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death[J]. N Engl J Med, 2014, 370(14): 1298-1306. DOI: 10.1056/NEJMoa 1309086. 

[33] Jacobson BC, Anderson JC, Burke CA, et al. Optimizing bowel preparation quality for colonoscopy: consensus recommendations by the US multi-society task force on colorectal cancer[J]. Am J Gastroenterol, 2025, 120(4): 738-764.DOI: 10.14309/ajg. 0000000000003287. 

[34] Zessner-Spitzenberg J, Waldmann E, Rockenbauer LM, et al. Impact of bowel preparation quality on colonoscopy findings and colorectal cancer deaths in a nation-wide colorectal cancer screening program[J]. Am J Gastroenterol, 2024,119(10):2036-2044. DOI: 10.14309/ ajg.0000000000002880. 

[35] Taveira F, Hassan C, Kaminski MF, et al. The colon endoscopic bubble scale (CEBuS): a two-phase evaluation study[J]. Endoscopy, 2022, 54(1): 45-51. DOI: 10.1055/ a-1331-4325. 

[36] Spadaccini M, Frazzoni L, Vanella G, et al. Efficacy and tolerability of high- vs low-volume split-dose bowel cleansing regimens for colonoscopy: a systematic review and Meta-analysis[J]. Clin Gastroenterol Hepatol, 2020, 18(7):1454-1465.e14. DOI: 10.1016/j.cgh. 2019.10. 044. 

[37] Baxter NN, Sutradhar R, Forbes SS, et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer[J]. Gastroenterology, 2011, 140(1): 65-72. DOI: 10.1053/j. gastro.2010.09.006. 

[38] Desai M, Rex DK, Bohm ME, et al. Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial[J]. Gastrointest Endosc, 2023,97(3):537-543. DOI: 10.1016/j.gie.2022.09.031. 

[39] Zhao S, Song Y, Wang S, et al. Reduced adenoma miss rate with 9-minute vs 6-minute withdrawal times for screening colonoscopy: a multicenter randomized tandem trial[J]. Am J Gastroenterol, 2023, 118(5): 802-811. DOI: 10.14309/ajg.0000000000002055. 

[40] Zhao S, Yang X, Wang S, et al. Impact of 9-minute withdrawal time on the adenoma detection rate: a multicenter randomized controlled trial[J]. Clin Gastroenterol Hepatol, 2022, 20(2): e168-e181. DOI: 10.1016/j.cgh.2020.11.019. 

[41] Jung Y, Joo Y, Kim HG, et al. Relationship between the endoscopic withdrawal time and adenoma/polyp detection rate in individual colonic segments: a KASID multicenter study[J]. Gastrointest Endosc, 2019, 89(3): 523-530. DOI: 10.1016/j.gie.2018.09.016. 

[42] Patel VD, Thompson WK, Lapin BR, et al. Screening colonoscopy withdrawal time threshold for adequate proximal serrated polyp detection rate[J]. Dig Dis Sci, 2018, 63(11): 3084-3090. DOI: 10.1007/s10620-018- 5187-0. 

[43] Shaukat A, Rector TS, Church TR, et al. Longer withdrawal time is associated with a reduced incidence of interval cancer after screening colonoscopy[J]. Gastroenterology, 2015, 149(4): 952-957. DOI: 10.1053/j. gastro. 2015. 06.044. 

[44] Jahn B, Bundo M, Arvandi M, et al. One in three adenomas could be missed by white-light colonoscopy - findings from a systematic review and meta-analysis[J]. BMC Gastroenterol, 2025, 25(1): 170. DOI: 10.1186/s12876- 025-03679-4. 

[45] Uraoka T, Igarashi M. Development and clinical usefulness of a unique red dichromatic imaging technology in gastrointestinal endoscopy: a narrative review[J]. Therap Adv Gastroenterol, 2022, 15: 17562848221118302. DOI: 10.1177/17562848221118302.

[46] Yoshida N, Inoue K, Dohi O, et al. Analysis of texture and color enhancement imaging for improving the visibility of non-polypoid colorectal Lesions[J]. Dig Dis Sci, 2022, 67(12): 5657-5665. DOI: 10.1007/s10620-022-07460-5. 

[47] Ikematsu H, Sakamoto T, Togashi K, et al. Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial[J]. Gastrointest Endosc, 2017, 86(2):386-394. DOI: 10.1016/j.gie.2017.01.017. 

[48] Suzuki T, Hara T, Kitagawa Y, et al. Linked-color imaging improves endoscopic visibility of colorectal nongranular flat lesions[J]. Gastrointest Endosc, 2017, 86(4): 692-697. DOI: 10.1016/j.gie.2017.01.044. 

[49] East JE, Vleugels JL, Roelandt P, et al. Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review[J]. Endoscopy, 2016,48(11):1029-1045. DOI: 10.1055/s-0042-118087. 

[50] McGill SK, Evangelou E, Ioannidis JP, et al. Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics[J]. Gut, 2013,62(12): 1704-1713. DOI: 10.1136/gutjnl-2012-303965. 

[51] Atkinson NSS, Ket S, Bassett P, et al. Narrow-band imaging for detection of neoplasia at colonoscopy: a meta-analysis of data from individual patients in randomized controlled trials[J]. Gastroenterology, 2019, 157(2): 462-471. DOI: 10.1053/j.gastro.2019.04.014. 

[52] Leung WK, Lo OSH, Liu KSH, et al. Detection of colorectal adenoma by narrow band imaging (HQ190) vs. high-definition white light colonoscopy: a randomized controlled trial[J]. Am J Gastroenterol, 2014, 109(6): 855-863. DOI: 10.1038/ajg.2014.83. 

[53] Hasegawa I, Yamamura T, Suzuki H, et al. Detection of colorectal neoplasms using linked color imaging: a prospective, randomized, tandem colonoscopy trial[J]. Clin Gastroenterol Hepatol, 2021, 19(8): 1708-1716. DOI: 10.1016/j.cgh.2021.04.004. 

[54] Paggi S, Radaelli F, Senore C, et al. Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program[J]. Gastrointest Endosc, 2020, 92(3):723-730. DOI: 10.1016/j.gie.2020.05.044. 

[55] Fujimoto D, Muguruma N, Okamoto K, et al. Linked color imaging enhances endoscopic detection of sessile serrated adenoma/polyps[J]. Endosc Int Open, 2018, 6(3): E322-E334. DOI: 10.1055/s-0043-124469. 

[56] Staudenmann D, Liu K, Varma P, et al. Narrow band imaging versus white light for detecting sessile serrated lesion: a prospective randomized multicenter study[J]. DEN Open, 2022,2(1):e44. DOI: 10.1002/deo2.44. 

[57] Soleymanjahi S, Huebner J, Elmansy L, et al. Artificial intelligence-assisted colonoscopy for polyp detection : a systematic review and Meta-analysis[J]. Ann Intern Med, 2024, 177(12): 1652-1663. DOI: 10.7326/ANNALS-24- 00981. 

[58] Hassan C, Rizkala T, Mori Y, et al. Computer-aided diagnosis for the resect-and-discard strategy for colorectal polyps: a systematic review and meta-analysis [J]. Lancet Gastroenterol Hepatol, 2024,9(11):1010-1019. DOI: 10.1016/S2468-1253(24)00222-X. 

[59] Patel HK, Mori Y, Hassan C, et al. Lack of effectiveness of computer aided detection for colorectal neoplasia: a systematic review and Meta-analysis of nonrandomized studies[J]. Clin Gastroenterol Hepatol, 2024, 22(5): 971- 980. DOI: 10.1016/j.cgh.2023.11.029. 

[60] Rizkala T, Hassan C, Mori Y, et al. Accuracy of computer-aided diagnosis in colonoscopy varies according to polyp location: a systematic review and Meta-analysis[J]. Clin Gastroenterol Hepatol, 2025,23(4): 531-541. DOI: 10.1016/j.cgh.2024.08.021. 

[61] Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system[J]. Histopathology, 2020, 76(2): 182-188. DOI: 10.1111/his. 13975. 

[62] Cho YB, Chun H, Yun HR, et al. Histological grade predicts survival time associated with recurrence after resection for colorectal cancer[J]. Hepatogastroenterology, 2009, 56(94-95):1335-1340. 

[63] College of American Pathologists. Protocol for the examination of excisional biopsy or polypectomy specimens from patients with primary carcinoma of the colon and rectum[EB/OL]. [2025-05-17] (2025-10-12). https://www. cap. org/protocols-and-guidelines/cancerreporting-tools/cancer-protocol-templates. 

[64] Ueno H, Mochizuki H, Hashiguchi Y, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma [J]. Gastroenterology, 2004, 127(2): 385-394. DOI: 10. 1053/j. gastro.2004.04.022. 

[65] Haggitt RC, Glotzbach RE, Soffer EE, et al. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy[J]. Gastroenterology, 1985, 89(2): 328-336. DOI: 10.1016/0016-5085(85)90333-6. 

[66] Tanaka S, Kashida H, Saito Y, et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection[J]. Dig Endosc, 2020, 32(2): 219-239. DOI: 10.1111/den.13545. 

[67] 国家卫生健康委员会医政司,中华医学会肿瘤学分会.国家 卫生健康委员会中国结直肠癌诊疗规范(2023版)[J].中华 胃肠外科杂志,2023,26(6):505-528. DOI:10.3760/cma.j. cn441530-20230525-00182. 

[68] Derwinger K, Kodeda K, Bexe-Lindskog E, et al. Tumour differentiation grade is associated with TNM staging and the risk of node metastasis in colorectal cancer[J]. Acta Oncol, 2010,49(1):57-62. DOI: 10.3109/0284186090333 4411. 

[69] Kitajima K, Fujimori T, Fujii S, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study[J]. J Gastroenterol, 2004, 39(6): 534-543. DOI: 10.1007/s00535-004-1339-4. 

[70] Wada H, Shiozawa M, Sugano N, et al. Lymphatic invasion identified with D2-40 immunostaining as a risk factor of nodal metastasis in T1 colorectal cancer[J]. Int J Clin Oncol, 2013, 18(6): 1025-1031. DOI: 10.1007/s10147- 012-0490-9. 

[71] Zhang B, Lin Y, Wang C, et al. Combining perineural invasion with staging improve the prognostic accuracy in colorectal cancer: a retrospective cohort study[J]. BMC Cancer, 2023, 23(1): 675. DOI: 10.1186/s12885-023- 11114-8. 

[72] Pai RK, Cheng Y, Jakubowski MA, et al. Colorectal carcinomas with submucosal invasion (pT1): analysis of histopathological and molecular factors predicting lymph node metastasis[J]. Mod Pathol, 2017, 30(1): 113-122. DOI: 10.1038/modpathol.2016.166. 

[73] Lugli A, Kirsch R, Ajioka Y, et al. Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016[J]. Mod Pathol, 2017, 30(9): 1299-1311. DOI: 10.1038/modpathol.2017.46. 

[74] Umar A, Boland CR, Terdiman JP, et al. Revised bethesda guidelines for hereditary nonpolyposis colorectal cancer (Lynch syndrome) and microsatellite instability[J]. J Natl Cancer Inst, 2004, 96(4): 261-268. DOI: 10.1093/jnci/ djh034. 

[75] Cârțână ET, Gheonea DI, Săftoiu A. Advances in endoscopic ultrasound imaging of colorectal diseases[J]. World J Gastroenterol, 2016, 22(5): 1756-1766. DOI: 10.3748/wjg.v22. i5.1756. 

[76] Nerad E, Lahaye MJ, Maas M, et al. Diagnostic accuracy of CT for local staging of colon cancer: a systematic review and Meta-analysis[J]. AJR Am J Roentgenol, 2016,207(5): 984-995. DOI: 10.2214/AJR.15.15785. 

[77] Zhuang Z, Zhang Y, Wei M, et al. Magnetic resonance imaging evaluation of the accuracy of various lymph node staging criteria in rectal cancer: a systematic review and Meta-analysis[J]. Front Oncol, 2021, 11: 709070. DOI: 10. 3389/fonc.2021.709070. 

[78] Rooney S, Meyer J, Afzal Z, et al. The role of preoperative imaging in the detection of lateral lymph node metastases in rectal cancer: a systematic review and diagnostic test meta-analysis[J]. Dis Colon Rectum, 2022, 65(12): 1436- 1446. DOI: 10.1097/DCR.0000000000002537. 

[79] Abbaspour E, Karimzadhagh S, Monsef A, et al. Application of radiomics for preoperative prediction of lymph node metastasis in colorectal cancer: a systematic review and meta-analysis[J]. Int J Surg, 2024, 110(6): 3795-3813. DOI: 10.1097/JS9.0000000000001239. 

[80] Kudo S, Ichimasa K, Villard B, et al. Artificial intelligence system to determine risk of T1 colorectal cancer metastasis to lymph node[J]. Gastroenterology, 2021, 160(4):1075-1084. DOI: 10.1053/j.gastro.2020.09.027. 

[81] Song JH, Hong Y, Kim ER, et al. Utility of artificial intelligence with deep learning of hematoxylin and eosin-stained whole slide images to predict lymph node metastasis in T1 colorectal cancer using endoscopically resected specimens; prediction of lymph node metastasis in T1 colorectal cancer[J]. J Gastroenterol, 2022, 57(9): 654-666. DOI: 10.1007/s00535-022-01894-4. 

[82] Miyazaki K, Wada Y, Okuno K, et al. An exosome-based liquid biopsy signature for pre-operative identification of lymph node metastasis in patients with pathological high-risk T1 colorectal cancer[J]. Mol Cancer, 2023,22(1): 2. DOI: 10.1186/s12943-022-01685-8. 

[83] Wada Y, Shimada M, Murano T, et al. A Liquid biopsy assay for noninvasive identification of lymph node metastases in T1 colorectal cancer[J]. Gastroenterology, 2021,161(1): 151-162. DOI: 10.1053/j.gastro.2021.03.062. 

[84] Luigiano C, Consolo P, Scaffidi MG, et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up[J]. Endoscopy, 2009,41(10):829-835. DOI: 10.1055/s-0029-1215091. 

[85] Kaltenbach T, Friedland S, Maheshwari A, et al. Short- and long-term outcomes of standardized EMR of nonpolypoid (flat and depressed) colorectal lesions > or = 1 cm (with video)[J]. Gastrointest Endosc,2007,65(6):857-865. DOI: 10.1016/j.gie.2006.11.035. 

[86] Hassan C, Repici A, Sharma P, et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis[J]. Gut, 2016,65(5): 806-820. DOI: 10.1136/gutjnl-2014-308481. 

[87] Belderbos TDG, Leenders M, Moons LMG, et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis[J]. Endoscopy, 2014, 46(5): 388-402. DOI: 10.1055/s-0034-1364970. 

[88] Ohata K, Kobayashi N, Sakai E, et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan[J]. Gastroenterology, 2022, 163(5): 1423-1434. DOI: 10.1053/j. gastro. 2022. 07.002. 

[89] Jacques J, Schaefer M, Wallenhorst T, et al. Endoscopic en bloc versus piecemeal resection of large nonpedunculated colonic adenomas : a randomized comparative trial[J]. Ann Intern Med, 2024,177(1):29-38. DOI: 10.7326/M23-1812. 

[90] Probst A, Golger D, Anthuber M, et al. Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European center[J]. Endoscopy, 2012, 44(7): 660-667. DOI: 10.1055/ s-0032-1309403. 

[91] Bahin FF, Heitman SJ, Rasouli KN, et al. Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis[J]. Gut, 2018,67(11): 1965-1973. DOI: 10.1136/gutjnl-2017-313823. 

[92] van der Schee L, Albers SC, Didden P, et al. Results of endoscopic intermuscular dissection for deep submucosal invasive rectal cancer: a three-year follow-up study[J]. Gut, 2025,DOI: 10.1136/gutjnl-2024-334612. 

[93] 中国医师协会外科医师分会经肛腔镜外科专家工作组.中国经肛腔镜手术专家共识及操作指南(2023版)[J].中华胃肠外科杂志 , 2023, 26(8): 729-739. DOI: 10.3760/cma. j. cn441530-20230705-00237. 

[94] Wang C, Huang T, Wang X. Efficacy and safety of transanal endoscopic microsurgery for early rectal cancer: a meta-analysis[J]. Front Oncol, 2025, 15: 1545547. DOI: 10.3389/fonc. 2025.1545547. 

[95] Meng Z, Liu Z. Comparison of local excision and total mesorectal excision for rectal cancer: Systematic review and meta-analysis of randomised controlled trial[J]. Heliyon, 2024, 10(9): e30027. DOI: 10.1016/j. heliyon. 2024.e30027. 

[96] Lee L, Burke JP, deBeche-Adams T, et al. Transanal mini‐ mally invasive surgery for local excision of benign and ma‐ lignant rectal neoplasia: outcomes from 200 consecutive cases with midterm follow up[J].Ann Surg, 2018, 267(5): 910-916. DOI:10.1097/SLA.000000000000 2190. 

[97] Dekkers N, Dang H, van der Kraan J, et al. Risk of recurrence after local resection of T1 rectal cancer: a meta-analysis with meta-regression[J]. Surg Endosc, 2022, 36(12):9156-9168. DOI: 10.1007/s00464-022-09396-3. 

[98] 孙跃明, 张冬生, 封益飞等.早期结直肠癌非治愈性内镜切除术后追加外科手术的临床观察[J].中华胃肠外科杂志, 2020, 23(5): 486-491. DOI: 10.3760/cma. j. cn. 441530- 20190612-00239 

[99] Schmidt A, Neeff HP, Quante M. Endoscopic R1/Rx resection of T1 colorectal cancer-what next? [J]. Am J Gastroenterol, 2022, 117(4): 603-604. DOI: 10.14309/ ajg.0000000000001670. 

[100] Oka S, Tanaka S, Kajiwara Y, et al. Treatment decision for locally resected T1 colorectal carcinoma-verification of the Japanese guideline criteria for additional surgery based on long-term clinical outcomes[J]. Am J Gastroenterol, 2024,119(10):2019-2027. DOI: 10.14309/ ajg. 0000000000002715. 

[101] 中国抗癌协会结直肠肿瘤整合康复专业委员会,中国抗癌 协会消化道息肉及癌前病变专业委员会,中华医学会外科 学分会结直肠外科学组,等.早期结直肠癌内镜切除术后追加手术中国专家共识(2025 版)[J]. 中国实用外科杂志, 2025, 45(4): 361-369. DOI: 10. 19538/j. cjps. issn 1005- 2208.2025.04.01. 

[102] Cha JH, Kim J, Kim H, et al. The optimal timing of additional surgery after non-curative endoscopic resection to treat early gastric cancer: long-term follow-up study[J]. Sci Rep, 2019, 9(1): 18331. DOI: 10.1038/s41598-019-54778-8. 

[103] Joo HJ, Seok JU, Kim BC, et al. Effects of prior endoscopic resection on recurrence in patients with T1 colorectal cancer who underwent radical surgery[J]. Int J Colorectal Dis, 2023,38(1):167. DOI: 10.1007/s00384-023-04448-z. 

[104] Chen D, Chen H, Lv X, et al. Outcome and risk factors of ulcer healing after gastric endoscopic submucosal dissection: a systematic review and meta-analysis[J]. World J Gastrointest Surg, 2024,16(11):3568-3577. DOI: 10.4240/wjgs.v16.i11.3568. 

[105] Kim B, Park JJ, Moon HS, et al. The effect of tegoprazan on the treatment of endoscopic resection-induced artificial ulcers: a multicenter, randomized, active-controlled study [J]. Gut Liver, 2024, 18(2): 257-264. DOI: 10.5009/gnl 230242. 

[106] Choi JH, Kim ES, Lee YJ, et al. Comparison of quality of life and worry of cancer recurrence between endoscopic and surgical treatment for early gastric cancer[J]. Gastrointest Endosc, 2015, 82(2): 299-307. DOI: 10.1016/j. gie. 2015. 01.019. 

[107] Chen P, Kao Y, Yang P, et al. Long-term outcomes and lymph node metastasis following endoscopic resection with additional surgery or primary surgery for T1 colorectal cancer[J]. Sci Rep, 2025, 15(1): 2573. DOI: 10. 1038/s41598-024-84915-x. 

[108] Fadel MG, Ahmed M, Shaw A, et al. Oncological outcomes of local excision versus radical surgery for early rectal cancer in the context of staging and surveillance: a systematic review and meta-analysis[J]. Cancer Treat Rev, 2024,128:102753. DOI: 0.1016/j.ctrv. 2024.102753. 

[109] 中华医学会消化内镜学分会.消化内镜下纳米炭注射标记定位技术临床操作专家共识[J].中华消化内镜杂志, 2022, 39(11): 860-869. DOI: 10.3760/cma. j. cn321463-202210 18-00537. 

[110] Liu P, Tan J, Tan Q, et al. Application of carbon nanoparticles in tracing lymph nodes and locating tumors in colorectal cancer: a concise review[J]. Int J Nanomedicine, 2020, 15: 9671-9681. DOI: 10.2147/IJN. S281914. 

[111] Koimtzis G, Geropoulos G, Stefanopoulos L, et al. The role of carbon nanoparticles as lymph node tracers in colorectal cancer: a systematic review and Meta-analysis [J]. Int J Mol Sci, 2023, 24(20): 15293. DOI: 10.3390/ ijms242015293. 

[112] Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome[J]. Colorectal Dis, 2009,11(4):354-364; discussion 364-365. DOI: 10.1111/j.1463-1318.2008.01735.x. 

[113] Wang Q, Chen E, Cai Y, et al. Preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by using carbon nanoparticles in laparoscopy[J]. World J Surg Oncol, 2016, 14(1): 231. DOI: 10.1186/s12957- 016-0987-1. 

[114] Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer[J]. Int J Clin Oncol, 2020,25(1):1-42. DOI: 10.1007/s10147-019-01485-z. 

[115] 中华医学会外科学分会结直肠外科学组,张忠涛.结直肠癌多学科综合治疗协作组诊疗模式中国专家共识(2023 版) [J]. 中国实用外科杂志,2024,44(1):1-16.DOI:10.19538/j. cjps.issn1005-2208.2024.01.01. 

[116] Ouchi A, Komori K, Masahiro T, et al. How does omitting additional surgery after local excision affect the prognostic outcome of patients with high-risk T1 colorectal cancer? [J]. Ann Surg, 2024, 279(2): 290-296. DOI: 10.1097/SLA.0000000000006092. 

[117] van Oostendorp SE, Smits LJH, Vroom Y, et al. Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo) radiation, or no additional treatment[J]. Br J Surg, 2020, 107(13):1719-1730. DOI: 10.1002/bjs.12040. 

[118] Eikenboom EL, van der Werf-'t Lam AS, RodríguezGirondo M, et al. Universal immunohistochemistry for lynch syndrome: a systematic review and Meta-analysis of 58, 580 colorectal carcinomas[J]. Clin Gastroenterol Hepatol, 2022,20(3):e496-e507. DOI: 10.1016/j.cgh.2021. 04.021. 

[119] 张卫, 颜宏利, 高显华, 等 . 早发性结直肠癌[M]. 上海:上海科学技术出版社,2022. 

[120] 高显华,赵子夜,刘连杰,等.林奇综合征的筛查和诊治研究进展 [J]. 结直肠肛门外科, 2023, 29(2): 115-121. DOI: 10.19668/j.cnki.issn1674-0491.2023.02.003. 

[121] Seppälä TT, Latchford A, Negoi I, et al. European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the mallorca guidelines based on gene and gender[J]. Br J Surg, 2021, 108(5): 484-498. DOI: 10.1002/bjs.11902. 

[122] Church J, Burke C, McGannon E, et al. Predicting polyposis severity by proctoscopy: How reliable is it? [J]. Dis Colon Rectum, 2001,44(9):1249-1254. DOI: 10.1007/ BF02234779. 

[123] Nieuwenhuis MH, Mathus-Vliegen LM, Slors FJ, et al. Genotype-phenotype correlations as a guide in the management of familial adenomatous polyposis[J]. Clin Gastroenterol Hepatol, 2007,5(3):374-378. DOI: 10.1016/ j.cgh.2006.12.014.

[124] Sinha A, Tekkis PP, Rashid S, et al. Risk factors for secondary proctectomy in patients with familial adenomatous polyposis[J]. Br J Surg, 2010, 97(11): 1710- 1715. DOI: 10.1002/bjs.7202. 

[125] Shah SC, Itzkowitz SH. Colorectal cancer in inflammatory bowel disease: mechanisms and management[J]. Gastroenterology, 2022, 162(3): 715-730. DOI: 10.1053/j. gastro.2021.10. 035. 

[126] Gordon H, Biancone L, Fiorino G, et al. ECCO Guidelines on inflammatory bowel disease and malignancies[J]. J Crohns Colitis, 2023, 17(6): 827-854. DOI: 10.1093/eccojcc/jjac187. 

[127] 中华医学会外科学分会结直肠外科学组,中国医师协会肛肠医师分会炎症性肠病专业委员会.中国溃疡性结肠炎外 科治疗指南[J]. 中华炎性肠病杂志(中英文), 2022,6(1): 7-16. DOI:10.3760/cma.j.cn101480-20211207-00100. 

[128] Spinelli A, Bonovas S, Burisch J, et al. ECCO guidelines on therapeutics in ulcerative colitis: surgical treatment[J]. J Crohns Colitis, 2022, 16(2): 179-189. DOI: 10.1093/eccojcc/jjab177. 

[129] Lee GC, Deery SE, Kunitake H, et al. Comparable perioper‐ ative outcomes, long-term outcomes, and quality of life in a retrospective analysis of ulcerative colitis patients fol‐ lowing 2-stage versus 3-stage proctocolectomy with ileal pouch-anal anastomosis[J]. Int J Colorectal Dis, 2019, 34(3):491-499. DOI: 10.1007/s00384-018-03221-x. 

[130] 孟乔,丁士刚 .炎症性肠病癌变的防治进展[J].中国微创外科杂志, 2025, 25(4):238-243. DOI:10.3969/j.issn.1009- 6604.2025.04.009. 

[131] Adamina M, Minozzi S, Warusavitarne J, et al. ECCO Guidelines on therapeutics in Crohn's disease: surgical treatment[J]. J Crohns Colitis, 2024, 18(10): 1556-1582. DOI: 10.1093/ecco-jcc/jjae089. 

[132] Gonçalves MG, Silva J, Carvalho T, et al. Postcolonoscopy colorectal cancer in a referral center for colorectal cancer: prevalence and risk factors[J]. GE Port J Gastroenterol, 2023, 30(5):359-367. DOI: 10.1159/000526126. 

[133] Hotta K, Matsuda T, Sano Y, et al. Surveillance after endoscopic resection for colorectal tumors: a comprehensive review[J].Digestion,2025,106(2):131-137. DOI:10.1159/00054 2665. 

[134] Sancho-Muriel J, Pellino G, Cholewa H, et al. Early colorectal cancer diagnosed after endoscopic resection: conservative treatment is safe in most of the cases. Proposal for a risk-based management[J]. Cir Esp (Engl Ed), 2022, 100 (10):635-640. DOI: 10.1016/j.cireng.2022.08.018. 

[135] Bobay MC, Lahr RE, Shultz J, et al. Safety of first surveillance colonoscopy at 12 months after piecemeal EMR of large nonpedunculated colorectal lesions[J]. Gastrointest Endosc, 2024, 100(5): 905-913. DOI: 10. 1016/j.gie.2024.05.008. 

[136] Nakajima T, Sakamoto T, Hori S, et al. Optimal surveillance interval after piecemeal endoscopic mucosal resection for large colorectal neoplasia: a multicenter randomized controlled trial[J]. Surg Endosc, 2022,36(1):515-525. DOI: 10.1007/s00464-021-08311-6. 

[137] Mendelsohn RB, Hahn AI, Palmaira RL, et al. Early-onset colorectal cancer patients do not require shorter intervals for post-surgical surveillance colonoscopy[J]. Clin Gastroenterol Hepatol, 2024, 22(12): 2517-2525. DOI: 10.1016/j.cgh.2024.04.029. 

[138] Ballester MP, Mesonero F, Flórez-Diez P, et al. Adherence to endoscopic surveillance for advanced lesions and colorectal cancer in inflammatory bowel disease: an AEG and GETECCU collaborative cohort study[J]. Aliment Pharmacol Ther, 2022,55(11):1402-1413. DOI: 10.1111/ apt.16832. 

[139] Pohl H, Srivastava A, Bensen SP, et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study[J]. Gastroenterology, 2013,144(1):74-80. DOI: 10.1053/j.gastro.2012.09.043. 

[140] Kaminski MF, Wieszczy P, Rupinski M, et al. Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death[J]. Gastroenterology, 2017, 153(1):98-105. DOI: 10.1053/j.gastro.2017.04.006. 

[141] Rex DK, Anderson JC, Butterly LF, et al. Quality indicators for colonoscopy[J]. Gastrointest Endosc, 2024, 100(3): 352-381. DOI: 10.1016/j.gie.2024.04.2905. 

[142] Atkin W, Wooldrage K, Brenner A, et al. Adenoma surveil‐ lance and colorectal cancer incidence: a retrospective, multicentre, cohort study[J]. Lancet Oncol, 2017, 18(6): 823-834. DOI: 10.1016/S1470-2045(17)30187-0. 

[143] Giardiello FM, Allen JI, Axilbund JE, et al. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on colorectal cancer[J]. Gastroenterology, 2014, 147(2): 502-526. DOI: 10.1053/j.gastro. 2014.04.001.