Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 4118777, Japan.
Gastric Cancer. 2015 Apr;18(2):339-45. doi: 10.1007/s10120-014-0379-6. Epub 2014 May 3.
Widespread application of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) results in noncurative resection in some patients. The influence of preceding ESD on additional gastric resections has not been completely evaluated.
Endoscopic, surgical, and pathological records of 255 patients who underwent additional gastrectomy after noncurative ESD at a single prefectural cancer center from September 2002 to December 2010 were reviewed. The estimated gastric resection based on endoscopic images before ESD was compared with the actual gastric resection performed after ESD.
Altered gastric resection was performed in 4 (1.6%) of the 255 patients. In 3 patients, total gastrectomy was performed instead of distal gastrectomy; in 1 patient, distal gastrectomy was performed instead of pylorus-preserving gastrectomy because of an insufficient distance from the cardia or pylorus caused by contraction of the ESD scar. Standard gastrectomy including total or distal gastrectomy with D2 lymph node dissection was performed in 33 patients because of deep submucosal invasion with positive/indefinite vertical margins. The final pathology revealed pT2 or deeper in 10 patients.
In conclusion, 98.4% patients underwent the scheduled gastric resection before ESD, and the preceding gastric ESD had almost no influence on changing the gastric resection of the additional surgery. Although rare, the preceding ESD may necessitate alterations in gastric resection to widen the surgical area because of contraction of ESD scar for lesions near the cardia or pylorus. MINI ABSTRACT: A retrospective study of additional gastrectomy after noncurative ESD showed that the preceding ESD had almost no influence on changing the gastric resection of the additional surgery.
内镜黏膜下剥离术（ESD）广泛应用于早期胃癌（EGC），导致部分患者无法达到根治性切除。ESD 前对胃的影响尚未完全评估。
回顾性分析 2002 年 9 月至 2010 年 12 月在单一县级癌症中心接受非根治性 ESD 后行额外胃切除术的 255 例患者的内镜、手术和病理记录。比较 ESD 前内镜图像估计的胃切除术与 ESD 后实际进行的胃切除术。
在 255 例患者中，有 4 例（1.6%）行改变性胃切除术。3 例因 ESD 瘢痕收缩导致贲门或幽门距离不足，行全胃切除术代替远端胃切除术；1 例因 ESD 瘢痕收缩导致胃体残端不足，行保留幽门的胃切除术代替远端胃切除术。由于黏膜下深层浸润伴阳性/不确定垂直切缘，33 例患者行标准胃切除术，包括全胃或远端胃切除术及 D2 淋巴结清扫术。最终病理显示 10 例患者为 pT2 或更深。
总之，98.4%的患者在 ESD 前接受了预定的胃切除术，而之前的胃 ESD 几乎没有影响到额外手术的胃切除术改变。尽管很少见，但由于 ESD 瘢痕收缩导致贲门或幽门附近病变的手术区域扩大，可能需要改变胃切除术。
