Kim Young-Il, Kim Young-Woo, Choi Il Ju, Kim Chan Gyoo, Lee Jong Yeul, Cho Soo-Jeong, Eom Bang Wool, Yoon Hong Man, Ryu Keun Won, Kook Myeong-Cheorl
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Endoscopy. 2015 Apr;47(4):293-301. doi: 10.1055/s-0034-1391284. Epub 2015 Jan 27.
Endoscopic resection for early gastric cancers that meet the expanded indication is considered to be an investigational treatment. The study aim was to evaluate long-term outcomes of endoscopic resection compared with surgery for early gastric cancers meeting the expanded indication.
We retrospectively reviewed data from patients who underwent endoscopic resection or surgery for gastric cancers meeting the expanded indication between 2001 and 2009. Overall survival rate was the primary outcome; gastric cancer recurrence rates and complication rates were secondary outcomes.
Among 457 patients included, 165 underwent endoscopic resection and 292 surgery, with median follow-up duration of 58.6 months. The 5-year overall survival rates were 97.5 % and 97.0 % for endoscopic resection and surgery, respectively; Kaplan-Meier analysis showed no significant difference (P = 0.425). The 5-year gastric cancer recurrence rate was higher for endoscopic resection than for surgery (4.8 % vs. 0.3 %; P < 0.001) mainly because of metachronous cancers which developed only in the endoscopic resection group (9/165, 5.5 %). Most of the metachronous cancers (88.9 %) were curatively treated with endoscopic resection. Early complication rates were similar between the groups (P = 0.557), but the endoscopic resection group had more grade III or higher complications according to the Clavien-Dindo classification compared with the surgery group (4.8 % vs. 1.4 %, P = 0.026). Late complications occurred only following surgery (4.8 %, P = 0.004), and most (92.9 %) were grade III or higher.
Endoscopic resection may be an optimal alternative to surgery for gastric cancers that meet the expanded indication criteria, because of a comparable long-term overall survival rate.
对于符合扩大适应证的早期胃癌，内镜下切除被视为一种试验性治疗方法。本研究旨在评估符合扩大适应证的早期胃癌内镜下切除与手术治疗的长期疗效。
我们回顾性分析了2001年至2009年间接受内镜下切除或手术治疗的符合扩大适应证的胃癌患者的数据。总生存率是主要观察指标；胃癌复发率和并发症发生率是次要观察指标。
纳入的457例患者中，165例行内镜下切除，292例行手术，中位随访时间为58.6个月。内镜下切除组和手术组的5年总生存率分别为97.5%和97.0%；Kaplan-Meier分析显示无显著差异（P = 0.425）。内镜下切除组的5年胃癌复发率高于手术组（4.8%对0.3%；P < 0.001），主要原因是异时性癌仅在内镜下切除组发生（165例中有9例，5.5%）。大多数异时性癌（88.9%）通过内镜下切除得到了根治性治疗。两组的早期并发症发生率相似（P = 0.557），但根据Clavien-Dindo分类，内镜下切除组III级及以上并发症的发生率高于手术组（4.8%对1.4%，P = 0.026）。晚期并发症仅发生在手术后（4.8%，P = 0.004），且大多数（92.9%）为III级及以上。
对于符合扩大适应证标准的胃癌，内镜下切除可能是手术的最佳替代方法，因为其长期总生存率相当。
