Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Gastric Cancer. 2018 Jan;21(1):124-132. doi: 10.1007/s10120-017-0724-7. Epub 2017 May 8.
The standard treatment for clinical submucosal invasive (cT1b) early gastric cancer is gastrectomy. However, Japanese gastric cancer treatment guidelines list endoscopic submucosal dissection (ESD) as an option for treating limited early gastric cancer cases. ESD can be curative depending on the pathological characteristics of resected specimens. Thus, we aimed to clarify the benefits and disadvantages of preceding ESD for early gastric cancer.
We retrospectively analyzed patients who underwent ESD or curative gastrectomy for cT1b gastric cancer with differentiated adenocarcinoma 30 mm or less in diameter. Patients who underwent ESD irrespective of undergoing gastrectomy were assigned to the ESD group (n = 107), and those who underwent gastrectomy without undergoing ESD were assigned to the non-ESD group (n = 181). Clinicopathological characteristics were assessed, and the short-term and long-term outcomes of patients were compared.
The criteria for curative resection were satisfied by 83 patients (28.8%), and preceding ESD did not affect the surgical outcomes of gastrectomy. Two patients (1.9%) who underwent ESD had an unscheduled total gastrectomy. The en bloc and complete resection rates of ESD were 99.0% and 84.1% respectively. Nine patients (8.4%) experienced intraprocedure perforation and postprocedure bleeding caused by ESD. Overall survival (hazard ratio 1.38; P = 0.302) and cause-specific survival (hazard ratio 0.96; P = 0.944) were comparable between groups.
The stomach was preserved in 28.8% of patients, and preceding ESD did not show obvious disadvantages. Therefore, diagnostic ESD should be considered as an initial treatment for limited cT1b gastric cancer cases.
对于临床黏膜下浸润（cT1b）早期胃癌的标准治疗方法是胃切除术。然而，日本胃癌治疗指南将内镜黏膜下剥离术（ESD）列为治疗局限性早期胃癌的一种选择。ESD 可以通过切除标本的病理特征来治愈。因此，我们旨在明确 ESD 治疗早期胃癌的利弊。
我们回顾性分析了直径 30mm 或以下分化型腺癌 cT1b 胃癌患者接受 ESD 或根治性胃切除术的病例。接受 ESD 治疗且未接受胃切除术的患者被分配到 ESD 组（n=107），接受胃切除术且未接受 ESD 治疗的患者被分配到非 ESD 组（n=181）。评估了临床病理特征，并比较了患者的短期和长期结局。
83 例患者（28.8%）符合根治性切除标准，ESD 并不会影响胃切除术的手术结果。2 例（1.9%）接受 ESD 的患者行非计划性全胃切除术。ESD 的整块切除率和完全切除率分别为 99.0%和 84.1%。9 例（8.4%）患者在 ESD 过程中发生穿孔，术后发生出血。ESD 组与非 ESD 组之间的总生存率（风险比 1.38；P=0.302）和特定原因生存率（风险比 0.96；P=0.944）无差异。
28.8%的患者保留了胃，ESD 并没有明显的劣势。因此，诊断性 ESD 应被视为治疗局限性 cT1b 胃癌的初始治疗方法。
