Kim Shin Hee, Hong Su Jin
Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
Korean J Gastroenterol. 2017 Sep 25;70(3):128-133. doi: 10.4166/kjg.2017.70.3.128.
The cases of non-curative endoscopic resection (NCR) of early gastric cancer have increased due to the widespread use of endoscopic submucosal dissection (ESD). NCR is associated with augmenting chances of local recurrence and lymph node metastasis (LNM). Therefore, some additional treatment strategies after NCR are needed. Treatment strategies for NCR should be determined by considering the risk of residual tumor or local recurrence and LNM. Additional surgical treatment such as gastrectomy and lymph node dissection are recommended in patients who have high-risk of LNM. Close observation without additional treatment is considered for selected patients with a less possibility of local recurrence or LNM. Also it may be suggested if there is no or less benefit from surgery in elderly patients or patients with underlying diseases. Additional endoscopic procedures including ESD, endoscopic mucosal resection or argon coagulation therapy are suggested alternatively for highly selected patients not at risk of LNM based on the absolute or expanded criteria of ESD.
由于内镜下黏膜下剥离术（ESD）的广泛应用，早期胃癌非根治性内镜切除（NCR）的病例有所增加。NCR与局部复发和淋巴结转移（LNM）几率增加相关。因此，NCR术后需要一些额外的治疗策略。NCR的治疗策略应根据残留肿瘤或局部复发以及LNM的风险来确定。对于有高LNM风险的患者，建议进行额外的手术治疗，如胃切除术和淋巴结清扫术。对于局部复发或LNM可能性较小的特定患者，考虑不进行额外治疗的密切观察。如果老年患者或有基础疾病的患者手术没有或获益较少，也可能建议密切观察。对于根据ESD的绝对或扩展标准不具有LNM风险的高度特定患者，可选择建议进行包括ESD、内镜黏膜切除术或氩离子凝固治疗在内的额外内镜手术。
