Ishii Naoki, Omata Fumio, Fujisaki Junko, Hirasawa Toshiaki, Kaise Mitsuru, Hoteya Shu, Tanabe Satoshi, Ishido Kenji, Ohata Ken, Takita Maiko, Mine Tetsuya, Igarashi Muneki, Yoshida Tatsuya, Takeda Yuichi, Furumoto Yohei, Matsumoto Kenshi, Yahagi Naohisa, Nakashima Hirotaka, Wada Tomonori, Tagata Tomoko, Mitsunaga Atsushi
Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.
Endosc Int Open. 2017 May;5(5):E354-E362. doi: 10.1055/s-0043-104859.
Positive horizontal margins in resected specimens are sometimes encountered after endoscopic submucosal dissection (ESD) for early gastric cancers, and appropriate treatment strategies for these cases are not established. The aim of this study was to evaluate current empirical treatments for patients with positive horizontal or indeterminable margins after ESD. We performed a multicenter survey and data from 14 hospitals were collected. The pooled proportions of positive horizontal or indeterminable margins and those of patients followed up without early intervention were calculated using a logistic-normal random-effects model. For calculating pooled estimates, subgroup analyses of high- and non-high-volume centers were conducted. A total of 11,796 ESD cases were enrolled and 229 patients (2 %) had positive horizontal or indeterminable margins. Ninety-eight cases were treated within 30 days of ESD and 131 cases were followed up without early treatments. Pooled estimates of positive margins in high- and non-high-volume centers were 1 % (95 % CI: 1 % - 2 %) and 2 % (95 % CI: 1 % - 4 %), respectively, and were not heterogeneous ( = 0.191). The proportion of patients followed up without early intervention ranged from 30 % to 100 %. The pooled estimate was 68 % (95 % CI: 50 % - 83 %). The pooled estimates of high- and non-high-volume centers were 65 % (95 % CI: 38 % - 85 %) and 72 % (95 % CI: 44 % - 89 %), respectively, and were not heterogeneous ( = 0.692). There was insufficient consensus regarding treatment strategies used for early gastric cancer with positive horizontal or indeterminable margins after ESD. Further studies are required to establish a consensus.
早期胃癌内镜黏膜下剥离术（ESD）后，切除标本有时会出现水平切缘阳性情况，而针对这些病例的恰当治疗策略尚未确立。本研究旨在评估ESD后水平切缘阳性或切缘情况不确定患者目前的经验性治疗方法。我们开展了一项多中心调查，收集了14家医院的数据。使用逻辑正态随机效应模型计算水平切缘阳性或切缘情况不确定的合并比例以及未经早期干预进行随访的患者比例。为计算合并估计值，对高手术量中心和非高手术量中心进行了亚组分析。共纳入11796例ESD病例，229例患者（2%）水平切缘阳性或切缘情况不确定。98例在ESD后30天内接受治疗，131例未经早期治疗进行随访。高手术量中心和非高手术量中心切缘阳性的合并估计值分别为1%（95%CI：1% - 2%）和2%（95%CI：1% - 4%），且无异质性（I² = 0.191）。未经早期干预进行随访的患者比例在30%至100%之间。合并估计值为68%（95%CI：50% - 83%）。高手术量中心和非高手术量中心的合并估计值分别为65%（95%CI：38% - 85%）和72%（95%CI：44% - 89%），且无异质性（I² = 0.692）。对于ESD后水平切缘阳性或切缘情况不确定的早期胃癌所采用的治疗策略，尚未达成充分共识。需要进一步开展研究以达成共识。
