Kim Dae Yong, Hong Su Jin, Cho Gyu Seok, Jeong Gui Ae, Kim Hee Kyung, Han Jae Pil, Lee Yun Nah, Ko Bong Min, Lee Moon Sung
Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
Gut Liver. 2014 Sep;8(5):519-25. doi: 10.5009/gnl13061. Epub 2014 Apr 23.
BACKGROUND/AIMS: This study aimed to compare the outcomes of endoscopic submucosal dissection (ESD) and gastrectomy based on the two sets of indications for ESD, namely guideline criteria (GC) and expanded criteria (EC).
Between January 2004 and July 2007, 213 early gastric cancer (EGC) patients were enrolled in this study. Of these patients, 142 underwent ESD, and 71 underwent gastrectomy. We evaluated the clinical outcomes of these patients according to the criteria.
The complication rates in the ESD and gastrectomy groups were 8.5% and 28.2%, respectively. The duration of hospital stay was significantly shorter in the ESD group than the gastrectomy group according to the GC and EC (p<0.001 and p<0.001, respectively). There was no recurrence in the ESD and gastrectomy groups according to the GC, and the recurrence rates in the ESD and gastrectomy groups were 4.7% and 0.0% according to the EC, respectively (p=0.279). The occurrence rates of metachronous cancer in the ESD and gastrectomy groups were 5.7% and 5.0% according to the GC (p=1.000) and 7.5% and 0.0% according to the EC (p=0.055), respectively.
Based on safety, duration of hospital stay, and long-term outcomes, ESD may be an effective and safe first-line treatment for EGC according to the EC and GC.
背景/目的：本研究旨在根据内镜黏膜下剥离术（ESD）的两组指征，即指南标准（GC）和扩展标准（EC），比较ESD与胃切除术的治疗效果。
2004年1月至2007年7月，213例早期胃癌（EGC）患者纳入本研究。其中，142例行ESD，71例行胃切除术。我们根据标准评估了这些患者的临床结局。
ESD组和胃切除组的并发症发生率分别为8.5%和28.2%。根据GC和EC，ESD组的住院时间明显短于胃切除组（分别为p<0.001和p<0.001）。根据GC，ESD组和胃切除组均无复发，根据EC，ESD组和胃切除组的复发率分别为4.7%和0.0%（p=0.279）。根据GC，ESD组和胃切除组异时性癌的发生率分别为5.7%和5.0%（p=1.000），根据EC分别为7.5%和0.0%（p=0.055）。
基于安全性、住院时间和长期结局，根据EC和GC，ESD可能是EGC一种有效且安全的一线治疗方法。
