Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
United European Gastroenterol J. 2013 Dec;1(6):453-60. doi: 10.1177/2050640613508550.
Endoscopic submucosal dissection (ESD) is an optimal treatment for early gastric cancer (EGC) with negligible risk of lymph node metastasis; however, ESD is sometimes performed to treat lesions preoperatively contraindicated for the procedure due to various reasons. Here we aim to evaluate the treatment outcomes of ESD for lesions that were preoperatively contraindicated for ESD.
Clinicopathological data of 104 EGC lesions in 104 patients were reviewed retrospectively. The demographic characteristics of patients, reasons for ESD, treatment results, complications, and outcomes were assessed.
The major reasons for undergoing ESD included advanced age, desire to undergo ESD, and the existence of comorbidities. En-bloc and complete resection rates were 97 and 71%, respectively. Perforation and postoperative bleeding rates were 13 and 9%, respectively. Resection was beyond the expanded Japanese criteria for endoscopic treatment of EGC in 87 patients (84%), 41 (47%) of whom underwent additional therapy, including subsequent gastrectomy (29 patients) and photodynamic therapy (12 patients). The median follow-up period was 47 months, during which seven patients died from recurrent disease. The 5-year overall and disease-specific survival rates were 70 and 91.5%, respectively.
ESD is a technically demanding procedure for lesions preoperatively contraindicated for endoscopic resection. The curative resection rate was low, but the 5-year disease-specific survival rate of 91.5% was favourable. In experienced hands, ESD may be a treatment option for patients not suitable for radical surgery, and the relevant risk of complications must be considered before treatment.
内镜黏膜下剥离术（ESD）是治疗早期胃癌（EGC）的最佳方法，淋巴结转移风险极小；然而，由于各种原因，有时会对术前不适合该手术的病变进行 ESD 治疗。在这里，我们旨在评估因各种原因术前不适合 ESD 而接受 ESD 治疗的病变的治疗结果。
回顾性分析了 104 例患者的 104 个 EGC 病变的临床病理资料。评估了患者的人口统计学特征、ESD 的原因、治疗结果、并发症和结局。
行 ESD 的主要原因包括年龄较大、希望行 ESD 治疗以及存在合并症。整块和完全切除率分别为 97%和 71%。穿孔和术后出血率分别为 13%和 9%。87 例（84%）患者的切除范围超出了日本扩大内镜治疗 EGC 的标准，其中 41 例（47%）接受了额外的治疗，包括随后的胃切除术（29 例）和光动力疗法（12 例）。中位随访时间为 47 个月，7 例患者死于复发性疾病。5 年总生存率和疾病特异性生存率分别为 70%和 91.5%。
ESD 是一种对术前不适合内镜切除的病变具有挑战性的技术。根治性切除率较低，但 5 年疾病特异性生存率为 91.5%，结果良好。在有经验的医生手中，ESD 可能是不适合根治性手术的患者的一种治疗选择，在治疗前必须考虑相关并发症风险。
