Departments of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Surg Endosc. 2018 Feb;32(2):760-769. doi: 10.1007/s00464-017-5735-2. Epub 2017 Aug 8.
Surgical resection for esophagogastric junction (EGJ) tumors is more aggressive and worsens the quality of life of the patients and leads to poor prognosis even after surgery compared with tumors in other sites of the stomach. Endoscopic submucosal dissection (ESD) is a widely accepted treatment modality for premalignant lesions and early cancers in the stomach. However, EGJ tumor is one of the most technically difficult lesions to resect by ESD. Therefore, this study aimed to evaluate the therapeutic outcomes of ESD for EGJ epithelial neoplasms and to assess the predictive factors for incomplete resection.
We conducted a retrospective observational study of 48 patients who underwent ESD for adenomas and early cancers of the EGJ between March 2006 and November 2015 at the Pusan National University Hospital. Therapeutic outcomes of ESD and procedure-related adverse events were analyzed.
En bloc resection, complete resection, and curative resection rates were 96, 77, and 71%, respectively. Multivariate analyses showed that the presence of ulceration was an independent predictive factor for incomplete resection (odds ratio 21.3, 95% confidence interval 1.51-298.49; p = 0.023). The procedure-related bleeding, perforation, and stenosis rates were 8, 4, and 0%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range 6-72 months), local recurrence occurred in four patients with incomplete resection.
ESD is an effective, safe, and feasible treatment for EGJ epithelial neoplasms. However, the complete resection rate decreases for tumors with ulceration.
与胃其他部位的肿瘤相比，食管胃结合部（EGJ）肿瘤的外科切除更具侵袭性，会降低患者的生活质量，并导致术后预后不良。内镜黏膜下剥离术（ESD）是一种广泛接受的治疗胃前病变和早期癌症的方法。然而，EGJ 肿瘤是 ESD 切除难度最大的病变之一。因此，本研究旨在评估 ESD 治疗 EGJ 上皮性肿瘤的治疗效果，并评估不完全切除的预测因素。
我们对 2006 年 3 月至 2015 年 11 月在釜山国立大学医院接受 ESD 治疗的 48 例 EGJ 腺瘤和早期癌症患者进行了回顾性观察性研究。分析了 ESD 的治疗效果和与手术相关的不良事件。
整块切除、完全切除和根治性切除率分别为 96%、77%和 71%。多因素分析显示，溃疡的存在是不完全切除的独立预测因素（比值比 21.3，95%置信区间 1.51-298.49；p=0.023）。与手术相关的出血、穿孔和狭窄发生率分别为 8%、4%和 0%，均无需手术干预。在中位 25 个月（6-72 个月）的随访期间，4 例不完全切除的患者出现局部复发。
ESD 是治疗 EGJ 上皮性肿瘤的一种有效、安全且可行的方法。然而，对于有溃疡的肿瘤，完全切除率会降低。
