Goto O, Fujishiro M, Kodashima S, Ono S, Omata M
Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Endoscopy. 2009 Feb;41(2):118-22. doi: 10.1055/s-0028-1119452. Epub 2009 Feb 12.
Endoscopic submucosal dissection (ESD) is a novel, promising endoscopic technique for gastrointestinal neoplasms. We aimed to elucidate the feasibility of ESD as curative treatment for intestinal-type early gastric cancer (EGC) potentially without lymph-node metastases.
For the short-term analysis, 276 consecutive, intestinal-type EGCs, which fulfilled the criteria for node-negative EGC in 231 patients who had undergone ESD from January 2000 to March 2007, were retrospectively investigated. For the long-term analysis, 212 lesions checked by endoscopy later than 1 year or recurrence within 1 year after ESD were assessed for local recurrence, and 208 patients followed for over 1 year or to death within 1 year after ESD were assessed for metastases and survival. All lesions/patients were divided into three groups: intramucosal cancer without ulcerative findings (M-Ul[-]); intramucosal cancer with ulcerative findings, < or = 3 cm (M-Ul[+]); and slight invasive cancer into submucosa (< 500 microm), < or = 3 cm (SM1).
En bloc and complete resection rates were 96.7 % and 91.7 %, respectively. During a median follow-up of 36 months (range 2 - 93 months), two local recurrences occurred (0.9 %), which were detected at 2 and 6 months after ESD, respectively. During a median follow-up of 38 months (range 6 - 97 months), the 5-year overall and disease-specific survival rates were 96.2 % and 100 %, respectively, with neither lymph node nor other-organ metastasis; one patient died due to other disease 6 months after ESD. No disease-related death occurred. No significant differences were found between the groups in short- and long-term analyses.
The prognostic analyses demonstrated the validity of the criteria of node-negative intestinal-type EGC as curability criteria for ESD. ESD can be proposed as an alternative method to gastrectomy for the treatment of these EGCs.
内镜黏膜下剥离术（ESD）是一种用于治疗胃肠道肿瘤的新型且有前景的内镜技术。我们旨在阐明ESD作为潜在无淋巴结转移的肠型早期胃癌（EGC）的根治性治疗方法的可行性。
对于短期分析，回顾性研究了2000年1月至2007年3月期间接受ESD治疗的231例患者中符合淋巴结阴性EGC标准的276例连续性肠型EGC。对于长期分析，对ESD后1年以上内镜检查或1年内复发的212个病变进行局部复发评估，对ESD后随访1年以上或1年内死亡的208例患者进行转移和生存评估。所有病变/患者分为三组：无溃疡性表现的黏膜内癌（M-Ul[-]）；有溃疡性表现、直径≤3 cm的黏膜内癌（M-Ul[+]）；以及侵犯黏膜下层（<500微米）、直径≤3 cm的轻度浸润癌（SM1）。
整块切除率和完全切除率分别为96.7%和91.7%。在中位随访36个月（范围2 - 93个月）期间，发生了2例局部复发（0.9%），分别在ESD后2个月和6个月被发现。在中位随访38个月（范围6 - 97个月）期间，5年总生存率和疾病特异性生存率分别为96.2%和100%，无淋巴结转移和其他器官转移；1例患者在ESD后6个月因其他疾病死亡。无疾病相关死亡。短期和长期分析中各亚组之间未发现显著差异。
预后分析证明了淋巴结阴性肠型EGC标准作为ESD可治愈性标准的有效性。ESD可作为治疗这些EGC的胃切除术替代方法。
