Institute for Digestive Research, Digestive Disease Center, SoonChunHyang University Hospital, Seoul, Korea.
Gastrointest Endosc. 2010 May;71(6):920-6. doi: 10.1016/j.gie.2009.12.005. Epub 2010 Mar 24.
Endoscopic submucosal dissection (ESD) is increasingly being performed for early gastric cancers (EGCs) that are larger than 2 cm and those that are not intestinal-type (IT) cancers by Lauren's classification. The technical feasibility of ESD for these EGCs has not been fully evaluated.
To identify appropriate expanded indications for ESD of EGC.
A retrospective analysis of prospectively collected data was performed on consecutive patients who underwent ESD at a single tertiary center.
In total, 487 EGCs in 461 patients treated by ESD were classified by size and histologic type: IT EGCs 2 cm or less (257 lesions in 235 patients), IT EGCs larger than 2 cm (172 lesions in 168 patients), and non-IT EGCs (58 lesions in 58 patients).
Curative resections were assessed among the 3 groups, and logistic regression analysis was used to analyze factors related to curative resection.
The rates of curative resection significantly decreased from IT EGCs 2 cm or less (88.7%) to IT EGCs larger than 2 cm (73.3%) to non-IT EGCs (37.9%). Tumor size (>3 cm), ulceration, histologic type (non-IT), and piecemeal resection were independently unfavorable factors in curative resection.
Small sample size and short-term duration of follow-up study.
ESD with curative intent is technically most feasible for nonulcerative and IT EGCs smaller than 3 cm.
内镜黏膜下剥离术（ESD）越来越多地用于治疗直径大于 2cm 的早期胃癌（EGC）和Lauren 分类中不属于肠型（IT）的癌症。对于这些 EGC，ESD 的技术可行性尚未得到充分评估。
确定 ESD 治疗 EGC 的适当扩展适应证。
对在一家三级中心接受 ESD 治疗的连续患者进行前瞻性收集数据的回顾性分析。
共有 461 例患者的 487 个 EGC 按大小和组织学类型分类：IT EGCs 2cm 或更小（235 例患者中的 257 个病变）、IT EGCs 大于 2cm（168 例患者中的 172 个病变）和非 IT EGCs（58 例患者中的 58 个病变）。
评估 3 组的根治性切除率，并使用逻辑回归分析来分析与根治性切除相关的因素。
从 IT EGCs 2cm 或更小（88.7%）到 IT EGCs 大于 2cm（73.3%）到非 IT EGCs（37.9%），根治性切除率显著降低。肿瘤大小（>3cm）、溃疡、组织学类型（非 IT）和分片切除是根治性切除的独立不利因素。
样本量小且随访时间短。
对于非溃疡性和 IT EGCs，直径小于 3cm 的 ESD 具有最高的技术可行性。
