Choi Jun Young, Jeon Seong Woo, Cho Kwang Bum, Park Kyung Sik, Kim Eun Soo, Park Chang Keun, Chung Yun Jin, Kwon Joong Goo, Jung Jin Tae, Kim Eun Young, Kim Kyeong Ok, Jang Byung Ik, Lee Si Hyung, Park Jeong Bae, Yang Chang Hun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gastric Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, 474 Hakjeongdong, Buk-gu, Daegu, South Korea.
Surg Endosc. 2015 Jul;29(7):1842-9. doi: 10.1007/s00464-014-3874-2. Epub 2014 Oct 8.
Endoscopic submucosal dissection (ESD) has been widely performed for the treatment of early gastric cancer (EGC). The aim of this study is to examine the effectiveness of ESD in submucosal invasive gastric cancers (SM-GC), with a special focus on patients who underwent non-curative resection.
Data for 1,246 patients who underwent ESD for treatment of EGC at six medical centers in Daegu-Gyeongbuk, Korea, between February 2003 and May 2010 were collected. After retrospective analysis of ESD databases, 118 patients were enrolled and classified into three groups: (1) EGC with submucosal invasion less than 500 μm (SM1-GC) that met the expanded criteria (EC) (SM1 EC, n = 42); (2) SM1-GC that did not meet the EC (SM1 non-EC, n = 38); and (3) EGC with submucosal invasion greater than 500 μm (SM2-GC, n = 38).
The en bloc and complete resection rates did not differ significantly among the three groups. However, the curative resection rate was significantly better in the SM1 EC group (69.0%) compared to that in SM1 non-EC and SM2-GC groups (0% in both cases). Out of a total of 118 patients, 89 (75.4%) underwent non-curative resection, and cancer recurrence was observed in 9 (9/89, 10.1%). We analyzed the survival rate in these non-curative patients and the overall survival and disease-free survival did not differ significantly between patients that were treated with additional surgical resection and those that were simply followed up after ESD.
Non-curative resection in SM-GC does not always lead to cancer recurrence. Thus, if additional surgery cannot be performed because of the patient's unsuitable condition or refusal, a close follow-up with endoscopy can be considered as an alternative for carefully selected patients. Moreover, as the ESD technology continues to evolve, it might be possible to expand the criteria for curative ESD in patients with SM-GC.
内镜黏膜下剥离术（ESD）已广泛应用于早期胃癌（EGC）的治疗。本研究旨在探讨ESD治疗黏膜下浸润性胃癌（SM-GC）的有效性，特别关注接受非根治性切除的患者。
收集2003年2月至2010年5月在韩国大邱-庆北地区6家医疗中心接受ESD治疗EGC的1246例患者的数据。对ESD数据库进行回顾性分析后，纳入118例患者并分为三组：（1）符合扩大标准（EC）的黏膜下浸润小于500μm的EGC（SM1-GC）（SM1 EC组，n = 42）；（2）不符合EC的SM1-GC（SM1非EC组，n = 38）；（3）黏膜下浸润大于500μm的EGC（SM2-GC组，n = 38）。
三组的整块切除率和完全切除率无显著差异。然而，SM1 EC组的根治性切除率（69.0%）明显高于SM1非EC组和SM2-GC组（两组均为0%）。在118例患者中，89例（75.4%）接受了非根治性切除，9例（9/89，10.1%）出现癌症复发。我们分析了这些非根治性患者的生存率，接受额外手术切除的患者与ESD后单纯随访的患者的总生存率和无病生存率无显著差异。
SM-GC的非根治性切除并不总是导致癌症复发。因此，如果因患者身体状况不合适或拒绝而无法进行额外手术，对于精心挑选的患者，可考虑内镜密切随访作为替代方案。此外，随着ESD技术不断发展，有可能扩大SM-GC患者根治性ESD的标准。
