Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan,
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Digestion. 2019;99(1):52-58. doi: 10.1159/000494413. Epub 2018 Dec 14.
BACKGROUND/AIMS: The outcomes of salvage surgery for recurrence after non-curative endoscopic submucosal dissection (ESD) without additional radical surgery for early gastric cancer (EGC) remain unclear. We determined the recurrence patterns and outcomes of salvage surgery in such cases using data from a multicenter, retrospective study.
Of 15,785 patients who underwent ESD for EGC at 19 participating institutions between January 2000 and August 2011, 1,969 failed to meet the current curative criteria after ESD. Of these, 905 patients received no additional treatment. We evaluated the pattern of recurrence, clinical course after salvage surgery, and long-term survival rate for these patients.
Over a median 64-month follow-up period, recurrence was detected in 27 patients. Two patients with missing data were excluded. Three, seven, and 15 (60%) patients showed intragastric relapse, regional lymph node metastasis, and distant metastasis, respectively. The first line of treatment for recurrence in 1, 7, 6, and 11 patients was endoscopic treatment, salvage surgery, chemotherapy, and best supportive care, respectively. One patient survived without recurrence for 31 months after salvage surgery, one died of acute myocardial infarction 1 month after salvage surgery, and 5 showed recurrence at 0, 2, 3, 5, and 30 months after salvage surgery and eventually succumbed to the disease. The median survival times for all patients with recurrence and the 7 patients who underwent salvage surgery were 5 months after recurrence and 7 months after salvage surgery, respectively.
The survival rate after salvage surgery for recurrence after non-curative ESD without additional radical surgery for EGC is quite low, with distant metastasis being the most common recurrence pattern in these cases.
背景/目的：对于早期胃癌（EGC），非治愈性内镜黏膜下剥离术（ESD）后复发且未行额外根治性手术的患者，挽救性手术的结果尚不清楚。我们通过一项多中心回顾性研究的数据，确定了此类病例中挽救性手术的复发模式和结果。
在 2000 年 1 月至 2011 年 8 月期间，19 家参与机构对 15785 例 EGC 患者进行了 ESD，其中 1969 例 ESD 后未达到目前的治愈标准。其中 905 例患者未接受额外治疗。我们评估了这些患者的复发模式、挽救性手术后的临床过程和长期生存率。
在中位 64 个月的随访期间，发现 27 例患者复发。2 例患者数据缺失。3 例、7 例和 15 例（60%）患者分别表现为胃内复发、区域淋巴结转移和远处转移。1 例、7 例、6 例和 11 例患者的复发一线治疗分别为内镜治疗、挽救性手术、化疗和最佳支持治疗。1 例患者在挽救性手术后 31 个月无复发存活，1 例患者在挽救性手术后 1 个月死于急性心肌梗死，5 例患者在挽救性手术后 0、2、3、5 和 30 个月出现复发，最终死于该疾病。所有复发患者和 7 例接受挽救性手术患者的中位生存时间分别为复发后 5 个月和挽救性手术后 7 个月。
对于 EGC 非治愈性 ESD 后复发且未行额外根治性手术的患者，挽救性手术后的生存率相当低，此类患者最常见的复发模式是远处转移。
