Oh Sooyeon, Kim Sang Gyun, Choi Ji Min, Jin Eun Hyo, Kim Jee Hyun, Im Jong Pil, Kim Joo Sung, Jung Hyun Chae
Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 110-744, Republic of Korea.
Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea.
Surg Endosc. 2017 Mar;31(3):1093-1100. doi: 10.1007/s00464-016-5069-5. Epub 2016 Jun 28.
For residual gastric tumors (RT) found at the treated sites after endoscopic resections (ER), additional treatment options are additional ER, surgery or argon plasma coagulation (APC). Long-term efficacy of APC as the curative modality for RT has not been fully elucidated. This study aimed to investigate the efficacy and long-term outcome of APC for RT with relevant tumor factors.
Eighty-two patients who received ER for gastric adenocarcinoma or adenoma and were subsequently treated with APC for RT were reviewed retrospectively. Characteristics of the tumors curatively ablated with single-session of APC and the non-curatively ablated were compared by multiple logistic regression analysis. Overall rate of curative ablation and follow-up duration was calculated.
Initial tumor size <20 mm [odds ratio for second residual recurrence (OR) 0.16; 95 % confidence interval (CI) 0.039-0.63], en-bloc resection (OR 0.16; 95 % CI 0.039-0.72), histologic complete resection (OR 0.14; 95 % CI 0.028-0.66) and RT with flat or depressed type (OR 0.20; 95 % CI 0.051-0.77) were significantly associated with curative ablation of RT by single-session of APC. Anterior wall or lesser curvature location showed a tendency toward curative APC, but not reached statistical significance (OR 0.36; 95 % CI 0.11-1.16). A total of 60 patients (73.2 %) achieved curative ablation after single-session of APC. Eleven among the patients (n = 22) with second or more residual recurrence achieved curative ablation with one or two more additional sessions of APC. Overall rate of curative ablation was 86.6 % (71/82). From the last APC, the final curative ablation group (n = 71) has been followed up for 49.7 ± 37.4 months.
En-bloc resection, histologic complete resection, RT with flat or depressed type and initial tumor size less than 2 cm can be predictors of favorable clinical outcome of APC as an additional treatment for RT. For selected patients with RT, APC and close monitoring could be a reasonable alternative to immediate resection.
对于内镜切除（ER）后在治疗部位发现的残留胃肿瘤（RT），额外的治疗选择包括再次内镜切除、手术或氩离子凝固术（APC）。APC作为RT的治愈性治疗方式的长期疗效尚未完全阐明。本研究旨在探讨APC治疗RT的疗效及长期结局，并分析相关肿瘤因素。
回顾性分析82例接受胃腺癌或腺瘤内镜切除后因RT接受APC治疗的患者。通过多因素逻辑回归分析比较单次APC治愈性消融和未治愈性消融的肿瘤特征。计算总体治愈性消融率和随访时间。
初始肿瘤大小<20mm[二次残留复发的比值比（OR）为0.16；95%置信区间（CI）为0.039 - 0.63]、整块切除（OR为0.16；95%CI为0.039 - 0.72）、组织学完全切除（OR为0.14；95%CI为0.028 - 0.66）以及扁平或凹陷型RT（OR为0.20；95%CI为0.051 - 0.77）与单次APC治愈性消融RT显著相关。前壁或小弯侧位置有治愈性APC的趋势，但未达到统计学意义（OR为0.36；95%CI为0.11 - 1.16）。共有60例患者（73.2%）单次APC后实现治愈性消融。22例有二次或更多残留复发的患者中，11例通过一到两次额外的APC治疗实现治愈性消融。总体治愈性消融率为86.6%（71/82）。自最后一次APC治疗后，最终治愈性消融组（n = 71）已随访49.7±37.4个月。
整块切除、组织学完全切除、扁平或凹陷型RT以及初始肿瘤大小小于2cm可作为APC作为RT额外治疗的良好临床结局的预测指标。对于选定的RT患者，APC及密切监测可能是直接切除的合理替代方案。
