Meng Fan-Sheng, Zhang Zhao-Hong, Hong Yan-Yun, Li De-Jian, Lin Jie-Qiong, Chen Xin, Ji Feng
Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, 310000, China.
Department of Hematology, Linyi People's Hospital, Jiefang Road No. 27, Linyi, 276300, China.
Surg Endosc. 2016 Nov;30(11):5099-5107. doi: 10.1007/s00464-016-4860-7. Epub 2016 Mar 22.
Endoscopic submucosal dissection (ESD) has been used for the treatment of gastric submucosal tumors (SMTs). This study aims to compare clinical outcomes of ESD versus laparoscopic wedge resection (LWR) for gastric SMTs.
This is a retrospective cohort study. Patients with SMTs who underwent ESD or LWR were enrolled in this study at a university-affiliated hospital from January 2010 to October 2015. Preoperative endoscopic ultrasound and computed tomography were performed to determine origin of layer and growth pattern. Clinical outcomes including baseline demographics, tumor size, operation time, blood loss, hospital stay, cost, pathology and postoperative complications were compared.
From January 2010 to October 2015, 68 patients with SMTs received ESD and 47 patients with SMTs received LWR. There was no difference in age, gender, body mass index, origin of layer and proportion with symptoms between ESD group and LWR group. However, tumor size was significantly larger in the LWR group (37.1 mm) than in the ESD group (25.8 mm, P = 0.041). For patients with tumors smaller than 20 mm, ESD was associated with shorter mean operation time (89.7 ± 23.5 vs 117.6 ± 23.7 min, P = 0.043), less blood loss (4.9 ± 1.7 vs 72.3 ± 23.3 ml, P < 0.001), shorter length of hospital stay (3.6 ± 1.9 vs 6.9 ± 3.7 days, P = 0.024) and lower cost (2471 ± 573 vs 4498 ± 1257 dollars, P = 0.031) when compared with LWR. For patients with tumors between 20 mm and 50 mm, ESD was associated with shorter mean operation time (99.3 ± 27.8 vs 125.2 ± 31.5 min, P = 0.039), less blood loss (10.1 ± 5.3 vs 87.6 ± 31.3 ml, P < 0.001), shorter length of hospital stay (4.0 ± 1.7 vs 7.3 ± 4.5 days, P = 0.027) and lower cost (2783 ± 601 vs 4798 ± 1343 dollars, P = 0.033) when compared with LWR. There were no significant differences in terms of rates of en bloc resection, complete resection and complication and histological diagnosis regardless of tumor size.
ESD can achieve similar oncological outcomes when compared with surgery for treatment of gastric SMT smaller than 50 mm.
内镜黏膜下剥离术（ESD）已用于治疗胃黏膜下肿瘤（SMT）。本研究旨在比较ESD与腹腔镜楔形切除术（LWR）治疗胃SMT的临床疗效。
这是一项回顾性队列研究。2010年1月至2015年10月期间，在一家大学附属医院对接受ESD或LWR治疗的SMT患者进行了研究。术前行内镜超声和计算机断层扫描以确定肿瘤的起源层次和生长方式。比较了包括基线人口统计学、肿瘤大小、手术时间、失血量、住院时间、费用、病理及术后并发症等临床疗效。
2010年1月至2015年10月期间，68例SMT患者接受了ESD治疗，47例SMT患者接受了LWR治疗。ESD组和LWR组在年龄、性别、体重指数、肿瘤起源层次及有症状患者比例方面无差异。然而，LWR组的肿瘤大小（37.1mm）显著大于ESD组（25.8mm，P = 0.041）。对于肿瘤小于20mm的患者，与LWR相比，ESD的平均手术时间更短（89.7±23.5对117.6±23.7分钟，P = 0.043）、失血量更少（4.9±1.7对72.3±23.3ml，P < 0.001）、住院时间更短（3.6±1.9对6.9±3.7天，P = 0.024）且费用更低（2471±573对4498±1257美元，P = 0.031）。对于肿瘤大小在20mm至50mm之间的患者，与LWR相比，ESD的平均手术时间更短（99.3±2...
