Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Endoscopy. 2012 Feb;44(2):122-7. doi: 10.1055/s-0031-1291486. Epub 2012 Jan 23.
Endoscopic submucosal dissection (ESD) of undifferentiated-type early gastric cancer (UD-EGC) is technically feasible; however, the long-term clinical outcomes of the procedure have not yet been fully investigated. The aim of our study was to elucidate long-term outcomes of ESD for UD-EGC.
Between September 2003 and October 2009, a total of 153 patients were diagnosed endoscopically as having UD-EGC fulfilling the expanded criteria for ESD. After informed consent was obtained, 101 patients were selected to undergo ESD and 52 to undergo surgical operation. We assessed the clinical outcomes of ESD in 101 consecutive patients with 103 UD-EGC lesions who were undergoing ESD for the first time. The overall mortality and disease-free survival rates after ESD were evaluated as the long-term outcomes.
The rates of en bloc and curative resection were 99.0% (102/103) and 82.5% (85/103), respectively. We encountered one patient with nodal metastasis detected by computed tomography before diagnostic ESD, although curative resection of the primary lesion was achieved based on routine histological examination. Among the 78 patients without a past history of malignancy within the previous 5 years in whom curative resection of the primary lesion was achieved, no cases of local recurrence or distant metastasis were observed during follow-up; however, 1 synchronous and 2 metachronous lesions were detected in 2 patients (2.6%) after primary ESD. Thus, estimated over a median follow-up period of 40.0 months (range 19-92 months) and 36.0 months (range 9-92 months), the 3-and 5-year overall mortality rates were 1.9% and 3.9%, respectively, and the 3-and 5-year overall disease-free survival rates were both 96.7%.
Although our single-center retrospective study may be considered to be only preliminary, our data indicate that ESD for UD-EGC may yield good long-term outcomes.
内镜黏膜下剥离术（ESD）可用于治疗未分化型早期胃癌（UD-EGC），技术上是可行的；然而，该手术的长期临床效果尚未得到充分研究。本研究旨在阐明 ESD 治疗 UD-EGC 的长期效果。
2003 年 9 月至 2009 年 10 月，共有 153 例患者经内镜诊断为符合 ESD 扩大适应证的 UD-EGC。在获得知情同意后，101 例患者选择接受 ESD 治疗，52 例患者选择接受手术治疗。我们评估了 101 例连续患者的临床结果，这些患者首次接受 ESD 治疗，共涉及 103 个 UD-EGC 病变。评估 ESD 后的总死亡率和无疾病生存率作为长期结果。
整块切除率和根治性切除率分别为 99.0%（102/103）和 82.5%（85/103）。我们发现 1 例患者在诊断性 ESD 前通过计算机断层扫描发现淋巴结转移，尽管根据常规组织学检查实现了原发性病变的根治性切除。在 78 例无 5 年内恶性肿瘤病史的患者中，在实现原发性病变根治性切除后，在随访期间未观察到局部复发或远处转移；然而，在原发性 ESD 后，2 例患者（2.6%）分别检测到 1 个同步和 2 个异时性病变。因此，在中位随访期 40.0 个月（范围 19-92 个月）和 36.0 个月（范围 9-92 个月）时，估计 3 年和 5 年的总死亡率分别为 1.9%和 3.9%，3 年和 5 年的总无疾病生存率均为 96.7%。
尽管我们的单中心回顾性研究可能仅初步进行，但我们的数据表明 ESD 治疗 UD-EGC 可能获得良好的长期效果。
