Pathirana A, Poston G J
Department of Surgery, Royal Liverpool University Hospital, Liverpool, UK.
Eur J Surg Oncol. 2001 Feb;27(1):9-16. doi: 10.1053/ejso.2000.1041.
A significant proportion of gastric and oesophageal cancers are diagnosed at an early stage in Japan. Early cancer is not obvious to the untrained eye as the mucosal changes are subtle. Better awareness by endoscopists of the different appearances of early cancer probably contributes significantly to this high incidence in Japan. Routine use of chromoendoscopy in high risk patients is also helpful. Survival figures after open surgery for these early cancers are excellent. Although the mortality of open surgery for carcinoma of the stomach and oesophagus is low, the morbidity is still considerable. A stage of early cancer, when the lesion is limited to the mucosa has been demonstrated to have minimal risk of metastatic spread (even to the local lymph nodes). These lesions can be reliably diagnosed with the help of endoscopic ultrasound. Once diagnosed, endoscopic mucosal resection can be performed with low morbidity. This provides tissue for histological evaluation, which is a definite advantage over other ablative methods used to treat early gastric and oesophageal cancer. Gastric cancers which are difficult to resect endoscopically, can be dealt with laparoscopically with equally satisfactory results
在日本，相当一部分胃癌和食管癌是在早期被诊断出来的。早期癌症对于未经训练的人眼来说并不明显，因为黏膜变化很细微。内镜医师对早期癌症不同表现有更高的认知度，这可能是日本早期癌症高发病率的一个重要原因。对高危患者常规使用色素内镜检查也很有帮助。这些早期癌症接受开放手术后的生存率很高。虽然胃癌和食管癌开放手术的死亡率较低，但发病率仍然相当高。已经证实，当病变局限于黏膜时的早期癌症阶段发生转移扩散（甚至转移至局部淋巴结）的风险极小。借助内镜超声能够可靠地诊断这些病变。一旦确诊，内镜黏膜切除术的发病率较低。这能提供组织用于组织学评估，这相对于用于治疗早期胃癌和食管癌的其他消融方法而言是一个明显的优势。难以通过内镜切除的胃癌，可以通过腹腔镜手术处理，效果同样令人满意。
