Hoteya Shu, Iizuka Toshiro, Kikuchi Daisuke, Mitani Toshifumi, Matsui Akira, Ogawa Osamu, Furuhata Tsukasa, Yamashta Satoshi, Yamada Akihiro, Kaise Mitsuru, Yahagi Naohisa
Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan,
Gastric Cancer. 2014 Oct;17(4):697-702. doi: 10.1007/s10120-013-0325-z. Epub 2013 Dec 6.
Endoscopic submucosal dissection (ESD) is a widely accepted technique for the management of gastric tumors. However, residual or recurrent tumors can occur after ESD; currently, there is no adequate management strategy for these tumors. Thus, the aim of the present study was to establish a strategy of secondary ESD (sESD) for cases with positive lateral margins (LM+), which cause post-ESD residual or recurrent tumors.
Fifty-three lesions that were subjected to ESD were diagnosed as LM+ with suspected local residual tumor. The short- and long-term outcomes of early sESD (performed shortly after the initial ESD in LM+ cases to prevent local recurrence) were retrospectively compared with those of late sESD (performed after the detection of recurrent tumors).
Of the 53 LM+ cases, the local residual positive rate was 38.5 % (10/26) in those undergoing early sESD or additional surgery and the local recurrence rate was 29.6 % (8/27) in those that were not treated. Thus, the overall incidence of residual or recurrent tumors in LM+ cases was 34.0 % (18/53). Both early and late sESD had favorable outcomes with no severe complications: 100 % of early sESD resections were curative, compared with 86.7 % of late sESD resections, over the course of a mean (±SD) observation period of 50.8 ± 16.7 months. The performance of early sESD was significantly greater than that of late sESD (in terms of dissection speed).
Early sESD is more reliable than late sESD as a therapeutic strategy for salvaging residual tumors and for preventing recurrence. However, if a tumor has already recurred, late sESD remains useful.
内镜黏膜下剥离术（ESD）是一种被广泛接受的治疗胃肿瘤的技术。然而，ESD术后可能会出现残留或复发性肿瘤；目前，对于这些肿瘤尚无充分的管理策略。因此，本研究的目的是为切缘阳性（LM+）导致ESD术后残留或复发性肿瘤的病例建立二次ESD（sESD）策略。
53例接受ESD的病变被诊断为LM+且怀疑有局部残留肿瘤。回顾性比较早期sESD（在LM+病例初次ESD后不久进行以预防局部复发）和晚期sESD（在检测到复发性肿瘤后进行）的短期和长期结局。
在53例LM+病例中，接受早期sESD或额外手术的患者局部残留阳性率为38.5%（10/26），未接受治疗的患者局部复发率为29.6%（8/27）。因此，LM+病例中残留或复发性肿瘤的总发生率为34.0%（18/53）。早期和晚期sESD均取得了良好的结局，无严重并发症：在平均（±标准差）50.8±16.7个月的观察期内，早期sESD切除的治愈率为100%，晚期sESD切除的治愈率为86.7%。早期sESD的操作性能（在剥离速度方面）显著优于晚期sESD。
作为挽救残留肿瘤和预防复发的治疗策略，早期sESD比晚期sESD更可靠。然而，如果肿瘤已经复发，晚期sESD仍然有用。
