Ahn Ji Yong, Park Hee Jung, Park Young Soo, Lee Jeong Hoon, Choi Kwi-Sook, Jeong Kee Wook, Kim Do Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Jung Hwoon-Yong
Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Dig Dis Sci. 2016 Apr;61(4):1158-64. doi: 10.1007/s10620-015-3988-y. Epub 2015 Dec 29.
Endoscopic resection (ER) is considered carefully as a curative treatment option for selected cases of undifferentiated-type early gastric cancer (UEGC). This study investigated immediate endoscopic and long-term survival outcomes of patients with UEGC treated with ER.
A review of a database of 2483 EGC consecutively enrolled patients who underwent ER between January 2004 and December 2010 identified 101 patients with UEGC who met the expanded indications. Outcomes were investigated in these patients.
The rates of R0 en bloc and curative resection were 86 and 70 %, respectively. Of 30 tumors non-curatively resected, 17 were larger than 20 mm in diameter, 12 had positive resection margins, and 13 had submucosal or lymphovascular invasion on resection pathology. ER-related complications occurred in 12 patients (12 %), with all complications treated endoscopically without surgery. The median ER procedure time was 26 min [interquartile range (IQR) 20-39 min]. Only tumor location in the lower part of the stomach was significantly associated with curative ER (P = 0.038). Tumor recurrence was observed in seven patients at a median 17 months (IQR 12-47 months) after ER. During a median follow-up of 60 months (IQR 48-80 months), the 5-year overall mortality rates were 5 % in the curative and 4 % in the non-curative resection groups (P = 0.927). There were no gastric cancer-related deaths.
ER shows acceptable immediate endoscopic and long-term survival outcomes in selected patients with UEGC.
对于部分未分化型早期胃癌（UEGC）病例，内镜下切除术（ER）被谨慎视为一种根治性治疗选择。本研究调查了接受ER治疗的UEGC患者的即时内镜检查结果和长期生存结局。
回顾2004年1月至2010年12月期间连续纳入的2483例接受ER治疗的早期胃癌患者数据库，确定101例符合扩大适应症的UEGC患者。对这些患者的结局进行了调查。
R0整块切除率和根治性切除率分别为86%和70%。在30例非根治性切除的肿瘤中，17例直径大于20mm，12例切缘阳性，13例切除病理显示有黏膜下层或脉管侵犯。12例患者（12%）发生了与ER相关的并发症，所有并发症均通过内镜治疗而非手术治疗。ER手术的中位时间为26分钟[四分位间距（IQR）20 - 39分钟]。仅胃下部的肿瘤位置与根治性ER显著相关（P = 0.038）。ER术后中位17个月（IQR 12 - 47个月），7例患者出现肿瘤复发。在中位随访60个月（IQR 48 - 80个月）期间，根治性切除组和非根治性切除组的5年总死亡率分别为5%和4%（P = 0.927）。无胃癌相关死亡。
对于部分UEGC患者，ER显示出可接受的即时内镜检查结果和长期生存结局。
