Department of Gastroenterology, Cha Kumi Medical Center, Cha University College of Medicine, Gumi-si, South Korea.
Department of Surgery, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, South Korea.
Surg Endosc. 2018 Sep;32(9):3798-3805. doi: 10.1007/s00464-018-6105-4. Epub 2018 Feb 20.
Endoscopic submucosal dissection (ESD) with laparoscopic sentinel lymph node dissection (ESN) and endoscopic full-thickness gastric resection with laparoscopic sentinel lymph node dissection (Hybrid-natural orifice transluminal endoscopic surgery, Hybrid-NOTES) are minimally invasive treatment options for early gastric cancer (EGC) beyond the indications of ESD. This study aimed to evaluate the short- and long-term clinical outcomes of ESN and Hybrid-NOTES.
We retrospectively analyzed patients who had undergone ESN or Hybrid-NOTES for EGC from January 2009 to March 2013. A total of 48 patients, including 21 undergoing ESN and 27 undergoing Hybrid-NOTES, were enrolled. All patients had cancer stage T1N0M0, EGC less than 5 cm in size, and suspected submucosal invasion according to imaging or biopsy-proven diffuse-type histology.
In ESN and Hybrid-NOTES, the curative resection rates were 76.5% and 90.9% of patients, respectively. In the ESN group, 5 patients underwent an additional gastrectomy (1 for lymph node metastasis (LNM), 3 for surgical complications, and 1 for noncurative resection). In the Hybrid-NOTES group, 6 patients underwent additional gastrectomy, (1 for LNM, 3 for surgical complications, and 2 for noncurative resection). Of the 37 patients who were followed up in the long-term (a median follow-up of 59.8 months), one was found to have liver metastasis after ESN and received palliative chemotherapy.
ESN and Hybrid-NOTES have shown favorable long-term outcomes despite their technical limitations. These methods may be utilized as a bridge between ESD and gastrectomy in cases of EGC with a high risk of LNM beyond the ESD indications.
内镜黏膜下剥离术（ESD）联合腹腔镜前哨淋巴结清扫术（ESN）和内镜全层胃切除术联合腹腔镜前哨淋巴结清扫术（Hybrid-NOTES）是治疗超出 ESD 适应证的早期胃癌（EGC）的微创治疗选择。本研究旨在评估 ESN 和 Hybrid-NOTES 的短期和长期临床疗效。
我们回顾性分析了 2009 年 1 月至 2013 年 3 月期间接受 ESN 或 Hybrid-NOTES 治疗的 EGC 患者。共纳入 48 例患者，其中 21 例行 ESN，27 例行 Hybrid-NOTES。所有患者均为癌症分期 T1N0M0，肿瘤直径小于 5cm，根据影像学或活检证实弥漫型组织学表现疑似黏膜下侵犯。
ESN 和 Hybrid-NOTES 的根治性切除率分别为 76.5%和 90.9%。在 ESN 组中，5 例患者行追加胃切除术（1 例因淋巴结转移（LNM），3 例因手术并发症，1 例因非根治性切除）。在 Hybrid-NOTES 组中，6 例患者行追加胃切除术（1 例因 LNM，3 例因手术并发症，2 例因非根治性切除）。37 例长期随访患者（中位随访时间为 59.8 个月）中，1 例在 ESN 后发现肝转移，接受姑息化疗。
尽管存在技术限制，ESN 和 Hybrid-NOTES 仍显示出良好的长期疗效。对于超出 ESD 适应证、有较高 LNM 风险的 EGC 患者，这些方法可作为 ESD 和胃切除术之间的桥梁。
