Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
J Gastroenterol. 2019 Jun;54(6):511-520. doi: 10.1007/s00535-018-1528-1. Epub 2018 Nov 9.
Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the remnant stomach is a minimally invasive treatment. Few studies compared the technical difficulty of ESD involving the suture line and anastomosis, and information on long-term outcomes is insufficient. This study aimed to elucidate the short- and long-term outcomes of ESD for EGC in the remnant stomach.
We investigated patients who underwent ESD for EGC in the remnant stomach between September 2002 and March 2016. Clinicopathological data were retrieved to assess en bloc resection rates, complications, and long-term outcomes including overall survival and cause-specific survival.
A total of 136 consecutive patients with 165 lesions resected by 157 ESD procedures were retrospectively evaluated. The en bloc resection rate was 95.5%. Complications included 16 intraoperative perforations (10.2%), 2 delayed perforations (1.3%), and 15 delayed bleeding (9.6%), which were successfully treated with endoscopy. The en bloc resection rate was significantly higher in the suture line group (100%) and the non-anastomosis or suture line group (98.8%) than in the anastomosis group (82.9%). However, the intraoperative perforation rate was significantly higher in the anastomosis group (31.4%) than in other groups. The 5-year overall and cause-specific survival rates were 88.4% and 97.6%, respectively, during a median follow-up period of 50.7 months (interquartile range 30.8-91.3).
The long-term outcomes of ESD for EGC in the remnant stomach were favorable. However, ESD involving the anastomosis was a technically demanding procedure due to the low en bloc resection rate and high perforation rate.
内镜黏膜下剥离术（ESD）是治疗早期胃癌（EGC）的一种微创治疗方法。涉及缝合线和吻合口的 ESD 技术难度的研究较少，且长期结果的信息不足。本研究旨在阐明胃切除术后 EGC 的 ESD 的短期和长期结果。
我们调查了 2002 年 9 月至 2016 年 3 月间接受胃切除术后 EGC 内镜黏膜下剥离术的患者。检索临床病理资料以评估整块切除率、并发症以及包括总生存率和特定原因生存率在内的长期结果。
共回顾性评估了 136 例连续患者的 165 处病变，共进行了 157 例 ESD 手术。整块切除率为 95.5%。并发症包括 16 例术中穿孔（10.2%）、2 例迟发性穿孔（1.3%）和 15 例迟发性出血（9.6%），均通过内镜成功治疗。缝合线组（100%）和非吻合口或缝合线组（98.8%）的整块切除率明显高于吻合口组（82.9%）。然而，吻合口组的术中穿孔率（31.4%）明显高于其他组。中位随访 50.7 个月（四分位距 30.8-91.3）期间，5 年总生存率和特定原因生存率分别为 88.4%和 97.6%。
胃切除术后 EGC 的 ESD 长期结果良好。然而，涉及吻合口的 ESD 是一项技术要求较高的手术，因为整块切除率低，穿孔率高。
