Shim Choong Nam, Lee Sang Kil
Choong Nam Shim, Sang Kil Lee, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
World J Gastroenterol. 2014 Apr 14;20(14):3938-49. doi: 10.3748/wjg.v20.i14.3938.
Although endoscopic submucosal dissection (ESD) is now accepted for treatment of early gastric cancers (EGC) with negligible risk of lymph node (LN) metastasis, ESD for intramucosal undifferentiated type EGC without ulceration and with diameter ≤ 2 cm is regarded as an investigational treatment according to the Japanese gastric cancer treatment guidelines. This consideration was largely based on the analysis of surgically resected EGCs that contained undifferentiated type EGCs; however, results from several institutes showed some discrepancies in sample size and incidence of LN metastasis. Recently, some reports about the safety and efficacy of ESD for undifferentiated type EGC meeting the expanded criteria have been published. Nonetheless, only limited data are available regarding long-term outcomes of ESD for EGC with undifferentiated histology so far. At the same time, endoscopists cannot ignore the patients' desire to guarantee quality of life after the relatively non-invasive endoscopic treatment when compared to conventional surgery. To satisfy the needs of patients and provide solid evidence to support ESD for undifferentiated EGC, we need more delicate tools to predict undetected LN metastasis and more data that can reveal predictive factors for LN metastasis.
尽管内镜下黏膜剥离术（ESD）目前已被用于治疗淋巴结（LN）转移风险可忽略不计的早期胃癌（EGC），但根据日本胃癌治疗指南，对于直径≤2cm、无溃疡的黏膜内未分化型EGC，ESD仍被视为一种试验性治疗。这种考量很大程度上基于对包含未分化型EGC的手术切除EGC的分析；然而，几家机构的结果在样本量和LN转移发生率方面存在一些差异。最近，已经发表了一些关于符合扩大标准的未分化型EGC的ESD安全性和有效性的报告。尽管如此，到目前为止，关于未分化组织学类型的EGC的ESD长期结果的数据仍然有限。与此同时，与传统手术相比，内镜医师在相对无创的内镜治疗后不能忽视患者对保证生活质量的诉求。为了满足患者的需求并提供确凿证据支持对未分化型EGC进行ESD，我们需要更精密的工具来预测未检测到的LN转移，以及更多能够揭示LN转移预测因素的数据。
