Kim Ju Seok, Kang Sun Hyung, Moon Hee Seok, Lee Eaum Seok, Kim Seok Hyun, Sung Jae Kyu, Lee Byung Seok, Jeong Hyun Yong
Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
Medicine (Baltimore). 2017 Apr;96(17):e6710. doi: 10.1097/MD.0000000000006710.
This study evaluated the clinical outcome of endoscopic submucosal dissection (ESD) in minute submucosa (SM) invasion or undifferentiated early gastric cancer (EGC) and analyzed factors related to local recurrence after ESD.We retrospectively reviewed the chart of EGC patients, who underwent ESD at our tertiary hospital between January 2009 and 2015. The patients' characteristics and clinical outcomes were compared among an absolute indication, minute SM invasion, and undifferentiated EGC group.Of 885 total patients, 729 composed the absolute indication group; 65, the differentiated, SM invasion group; and 51, the undifferentiated, confined mucosa group. Follow-up was conducted for average (± standard deviation) 34.12 (± 10.6) months; as compared to the absolute indication group, both en bloc resection and curative resection rate were low in the other 2 groups, but there were no significant differences in procedure-related complication, local recurrence, and survival rate. Comparing the cases of ESD performed at our hospital from 2005 to 2009 with those performed between 2009 and 2015, en bloc resection (80.5% vs 89.1%, P = .001) and curative resection rate (86.2% vs 92.1%, P = .011) were higher in the latter study. Noncurative resection and tumor size of more than 2 cm were factors associated with local recurrence.ESD in minute SM invasion or undifferentiated EGC showed an unfavorable short-term outcome as compared to that in the absolute indication group, but there were no differences in local recurrence and overall survival rate. Therefore, in minute SM invasion or undifferentiated EGC patients, ESD could be recommended as a therapeutic option.
本研究评估了内镜黏膜下剥离术（ESD）治疗微小黏膜下层（SM）浸润或未分化早期胃癌（EGC）的临床结局，并分析了ESD术后局部复发的相关因素。我们回顾性分析了2009年1月至2015年期间在我院接受ESD治疗的EGC患者病历。比较了绝对适应证、微小SM浸润和未分化EGC组患者的特征及临床结局。在885例患者中，729例组成绝对适应证组；65例为分化型、SM浸润组；51例为未分化、局限于黏膜组。平均（±标准差）随访34.12（±10.6）个月；与绝对适应证组相比，其他两组的整块切除率和根治性切除率均较低，但在手术相关并发症、局部复发和生存率方面无显著差异。比较我院2005年至2009年与2009年至2015年期间进行的ESD病例，后一时期的整块切除率（80.5%对89.1%，P = 0.001）和根治性切除率（86.2%对92.1%，P = 0.011）更高。非根治性切除和肿瘤大小超过2 cm是与局部复发相关的因素。与绝对适应证组相比，微小SM浸润或未分化EGC的ESD短期结局不佳，但局部复发和总生存率无差异。因此，对于微小SM浸润或未分化EGC患者，可推荐ESD作为一种治疗选择。
