Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Gastric Cancer. 2017 Sep;20(5):843-852. doi: 10.1007/s10120-017-0691-z. Epub 2017 Jan 27.
Although extragastric recurrence after endoscopic resection of early gastric cancer is rare, it is important because of its potentially fatal outcomes. We investigated the patterns of extragastric recurrence after endoscopic resection and evaluated the role of abdominal computed tomography in surveillance.
Between July 1994 and June 2014, 4915 patients underwent endoscopic resection of early gastric cancer. Because of follow-up periods of less than 6 months and consecutive surgery within 1 year, 810 patients were excluded. Thus, 4105 patients were retrospectively reviewed.
The median follow-up period was 37 months (interquartile range 20-59.6 months). The overall incidence of extragastric recurrence was 0.37% (n = 15). In patients who underwent curative resection, the incidence was 0.14% (n = 5). There were three recurrences in the absolute indication group, six in the expanded indication group, and six in the beyond expanded indication group. The median time to extragastric recurrence was 17 months (interquartile range 16.5-43.2 months). Of the 15 extragastric recurrences, 11 were in the regional lymph nodes and 4 were in the liver, adrenal gland, and peritoneum. Sixty percent (9/15) of the extragastric recurrences occurred without intragastric lesions. Eleven recurrences were detected by abdominal computed tomography, and eight patients underwent curative surgery.
After endoscopic resection of early gastric cancer, regional lymph node recurrence is the predominant extragastric recurrence pattern, which can be detected via abdominal computed tomography and cured by rescue surgery. Abdominal computed tomography should be considered as a surveillance method, especially in patients with an expanded indication.
尽管内镜下切除早期胃癌后发生胃外复发的情况较为罕见，但仍需重视，因为其可能导致致命的后果。本研究旨在探讨内镜下切除早期胃癌后胃外复发的模式，并评估腹部 CT 在监测中的作用。
1994 年 7 月至 2014 年 6 月，共有 4915 例患者接受了内镜下切除早期胃癌的治疗。由于随访时间不足 6 个月或 1 年内连续手术的患者有 810 例，故将这 810 例患者排除在外，最终共对 4105 例患者进行了回顾性分析。
中位随访时间为 37 个月（四分位间距为 20-59.6 个月）。总的胃外复发率为 0.37%（n=15）。在接受根治性切除的患者中，胃外复发率为 0.14%（n=5）。绝对适应证组有 3 例复发，扩大适应证组有 6 例，超出扩大适应证组有 6 例。胃外复发的中位时间为 17 个月（四分位间距为 16.5-43.2 个月）。15 例胃外复发中，有 11 例位于区域淋巴结，4 例位于肝脏、肾上腺和腹膜。60%（9/15）的胃外复发无胃内病灶。15 例胃外复发中有 11 例通过腹部 CT 发现，其中 8 例行根治性手术。
内镜下切除早期胃癌后，区域淋巴结复发是主要的胃外复发模式，可通过腹部 CT 发现，并通过挽救性手术治愈。对于有扩大适应证的患者，应考虑将腹部 CT 作为一种监测方法。
