结直肠肿瘤在慢性肾病 (CKD) 患者中很常见；然而，结直肠内镜粘膜下剥离术（ESD）的安全性和有效性尚不清楚。这项回顾性分析包括 2015 年 1 月至 2020 年 12 月对五家三级医疗机构的 1266 名 CKD 患者进行的 ESD 手术。根据估计肾小球滤过率 (eGFR) 对患者进行分类，范围为 CKD1 至 CKD5（包括透析患者） 。我们发现，在所有 CKD 阶段，整块切除率仍然很高，这证实了 ESD 的手术效果。值得注意的是，随着 CKD 分期的进展，缺血性心脏病和糖尿病等心血管合并症的患病率显着增加，查尔森合并症指数也相应增加，凸显了管理这些患者的复杂性。尽管存在这些挑战，CKD5 组的完全切除率 (50%) 仍低于 CKD1 组 (83.4%)；然而，穿孔和出血等手术并发症在各组之间没有显着差异。完全切除和主要并发症的预测模型显示，随着 eGFR 的降低，没有显着变化。这些发现强调，ESD 是治疗 CKD 患者结直肠肿瘤的一种可行且安全的治疗方法，成功地平衡了固有的手术风险和临床获益。

Colorectal neoplasms are prevalent in patients with chronic kidney disease (CKD); however, the safety and efficacy of colorectal endoscopic submucosal dissection (ESD) are not well understood. This retrospective analysis included ESD procedures performed in 1266 patients with CKD across five tertiary medical institutions from January 2015 to December 2020. Patients were categorized based on their estimated glomerular filtration rate (eGFR), which ranged from CKD1 to CKD5 (including those on dialysis). We found that en bloc resection rates remained high across all CKD stages, affirming the procedural efficacy of ESD. Notably, the prevalence of cardiovascular comorbidities, such as ischemic heart disease and diabetes mellitus, significantly increased with an advancing CKD stage, with a corresponding increase in the Charlson Comorbidity Index, highlighting the complexity of managing these patients. Despite these challenges, the complete resection rate was lower in the CKD5 group (50%) than in the CKD1 group (83.4%); however, procedural complications, such as perforation and bleeding, did not significantly differ among the groups. The predictive models for complete resection and major complications showed no significant changes with a decreasing eGFR. These findings underscore that ESD is a feasible and safe treatment for colorectal neoplasms in patients with CKD, successfully balancing the inherent procedural risks with clinical benefits.