Pimentel-Nunes Pedro, Mourão Francisco, Veloso Nuno, Afonso Luís Pedro, Jácome Manuel, Moreira-Dias Luís, Dinis-Ribeiro Mário
Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal.
CINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal.
Endoscopy. 2014 Nov;46(11):933-40. doi: 10.1055/s-0034-1377348. Epub 2014 Jul 14.
Although endoscopic resection for the treatment of gastric superficial neoplastic lesions is an established first-line treatment in Eastern countries, its role has yet to be considered in Western guidelines, mostly due to a lack of long-term studies. The aim of this study was to describe long-term outcomes for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of gastric neoplasias in Portugal.
This was a single-center, retrospective, cohort study between March 2003 and April 2013. A total of 162 consecutive patients with 195 gastric superficial neoplasias underwent EMR (n = 54) or ESD (n = 141) and were followed up for a median of 3.2 years.
Resection was feasible in 97 %, with en bloc and R0 resection rates of 85 % (94 % ESD vs. 61 % EMR; P = 0.001) and 81 % (91 % ESD vs. 54 % EMR; P < 0.001), respectively. The recurrence rate was 7 %, and recurrence was associated with Rx/R1 resection irrespective of resection technique (OR 5.8; 95 % confidence interval 3.9 - 8.8). The long-term curative resection rate was 86 % after one procedure and 91 % after two procedures. Adverse events were observed in 13 % of cases: 8 % bleeding and 2 % of perforations (EMR = ESD). Surgery was performed in 7 %: 6 % after noncurative endoscopic resection and 1 % due to complications. Metachronous lesion detection rate was 1 % - 1.5 % per patient year. Cancer-specific survival rate was 100 % at follow-up.
For the first time in a Western country, results are reported to be similar to those in Eastern countries. Endoscopic resection, particularly ESD, is a highly effective treatment for gastric superficial lesions, without compromising cancer survival. Endoscopic resection should also be considered as first-line treatment for gastric neoplasias in Western countries.
尽管内镜下切除术治疗胃浅表性肿瘤病变在东方国家已是既定的一线治疗方法，但在西方指南中其作用尚未得到充分考虑，主要原因是缺乏长期研究。本研究的目的是描述葡萄牙内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）治疗胃肿瘤的长期疗效。
这是一项2003年3月至2013年4月间的单中心回顾性队列研究。共有162例连续患者的195处胃浅表性肿瘤接受了EMR（n = 54）或ESD（n = 141）治疗，并进行了中位时间为3.2年的随访。
97%的切除可行，整块切除率和R0切除率分别为85%（ESD为94%，EMR为61%；P = 0.001）和81%（ESD为91%，EMR为54%；P < 0.001）。复发率为7%，复发与Rx/R1切除相关，与切除技术无关（比值比5.8；95%置信区间3.9 - 8.8）。一次手术后长期根治性切除率为86%，两次手术后为91%。13%的病例观察到不良事件：8%出血，2%穿孔（EMR = ESD）。7%的患者接受了手术：6%在非根治性内镜切除后，1%因并发症。异时性病变检出率为每位患者每年1% - 1.5%。随访时癌症特异性生存率为100%。
在西方国家首次报道结果与东方国家相似。内镜下切除，尤其是ESD，是治疗胃浅表病变的高效方法，不影响癌症生存率。内镜下切除也应被视为西方国家胃肿瘤的一线治疗方法。
