Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Korea.
Surg Endosc. 2018 Jan;32(1):73-86. doi: 10.1007/s00464-017-5640-8. Epub 2017 Jun 21.
Endoscopic submucosal dissection (ESD) is accepted as a standard treatment in patients with early gastric cancer (EGC) who have a negligible risk of lymph node metastasis. The aim of this study was to compare the short-term and long-term outcomes between ESD and surgery in patients with EGC that fulfilled the expanded indication of ESD on their final pathologic report.
We reviewed the clinical data of patients who underwent gastric ESD and surgery between January 2007 and December 2012. Patients with pathologically confirmed EGC that fulfilled the expanded indication of ESD on their final pathologic report were analyzed.
Among 2023 patients, 817 (40.4%) underwent ESD and 1206 (59.6%) underwent surgery. The proportion of cases meeting the absolute indication was significantly higher in the ESD group than in the surgery group (66.0 vs. 26.2%). Lesions on the middle third, >3 cm in size, flat or depressed, and of undifferentiated histology were significantly more common in the surgery group than in the ESD group. The ESD group showed lower acute complication rates [8.1% (66 of 817) vs. 18.1% (218 of 1206), P ≤ 0.001] and procedure-related mortality [0 vs. 0.3% (4 of 1206), P = 0.153] than the surgical group. The annual incidence of recurrent gastric cancer was 2.18% in the ESD group and 0.19% in the surgery group. The 5-year overall and disease-specific survival rates were not significantly different between the ESD group and the surgery group (overall survival: 96.4 vs. 97.2%, P = 0.423; disease-specific survival: 99.6 vs. 99.2%, P = 0.203).
Although EGC lesions had poorer features in the surgery group than in the ESD group, ESD was comparable to surgery for EGCs that fulfilled the expanded indication of ESD, with lower rates of acute complication and comparable overall survival.
内镜黏膜下剥离术（ESD）被认为是早期胃癌（EGC）患者的标准治疗方法，这些患者淋巴结转移风险极小。本研究旨在比较 EGC 患者在最终病理报告中符合 ESD 扩大适应证的情况下，接受 ESD 和手术治疗的短期和长期结果。
我们回顾了 2007 年 1 月至 2012 年 12 月期间接受胃 ESD 和手术治疗的患者的临床资料。对最终病理报告中符合 ESD 扩大适应证的 EGC 患者进行分析。
在 2023 例患者中，817 例（40.4%）接受 ESD 治疗，1206 例（59.6%）接受手术治疗。ESD 组符合绝对适应证的病例比例明显高于手术组（66.0% vs. 26.2%）。ESD 组病变位于中三分之一、直径>3cm、平坦或凹陷、组织学分化程度低的病例明显多于手术组。ESD 组的急性并发症发生率较低[8.1%（66/817）vs. 18.1%（218/1206），P≤0.001]，手术相关死亡率为 0[0 vs. 0.3%（4/1206），P=0.153]低于手术组。ESD 组复发胃癌的年发生率为 2.18%，手术组为 0.19%。ESD 组和手术组的 5 年总生存率和疾病特异性生存率无显著差异（总生存率：96.4% vs. 97.2%，P=0.423；疾病特异性生存率：99.6% vs. 99.2%，P=0.203）。
尽管手术组 EGC 病变特征较 ESD 组差，但 ESD 与手术治疗符合 ESD 扩大适应证的 EGC 相似，急性并发症发生率较低，总生存率相当。
