Department of Emergency Surgical Endoscopy, Borgo Trento Hospital, Verona, Italy.
General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
Updates Surg. 2019 Jun;71(2):359-365. doi: 10.1007/s13304-019-00628-1. Epub 2019 Feb 1.
Endoscopic submucosal dissection (ESD) represents the standard of care for early gastric cancer in Eastern countries. Nevertheless, in the West, this procedure is not widespread. Aim of the study was to confirm the feasibility and the efficacy of ESD in the West. A total of 60 ESD were performed between January 2005 and December 2014 by two expert endoscopists. The analysis, based on a retrospective collected database, was conducted by dividing the study period in three subgroups. Clinical and technical outcomes have been compared. Rates of complete, curative and en bloc resection did not significantly change among the study periods. Three cases of perforation occurred (5%), one in each period. The operation time significantly decreased from the second to the third period (p < 0.001). When adjusting for gender, tumor size and site in multivariable analysis, operation time decreased by nearly 90 min from the first to the second period, and by more than 3 h from the first to the last period. The median follow-up was 33 months. No cases of local or lymphnodal recurrence were detected during the study period. One patient presented a synchronous lesion, whilst four metachronous lesions have been discovered after a median follow-up of 11 months. Our experience supports the feasibility and safety of ESD in the West, if an adequate learning curve is accomplished. Long-term outcomes are comparable to the Eastern series.
内镜黏膜下剥离术（ESD）是治疗东亚国家早期胃癌的标准方法。然而，在西方国家，这种方法并不广泛。本研究旨在证实 ESD 在西方国家的可行性和疗效。两位专家内镜医生于 2005 年 1 月至 2014 年 12 月期间共进行了 60 例 ESD。本研究基于回顾性收集的数据库进行分析，并将研究期间分为三个亚组。比较了临床和技术结果。完全切除、治愈性切除和整块切除的比例在各研究期间没有显著变化。有 3 例穿孔（5%），每例发生在一个时期。手术时间从第二期到第三期显著缩短（p<0.001）。在多变量分析中，当调整性别、肿瘤大小和部位时，手术时间从第一期到第二期减少了近 90 分钟，从第一期到最后一期减少了 3 个多小时。中位随访时间为 33 个月。研究期间未发现局部或淋巴结复发病例。1 例患者出现同步病变，4 例患者在中位随访 11 个月后发现异时性病变。我们的经验支持在西方国家进行 ESD 的可行性和安全性，如果能够完成适当的学习曲线。长期结果与东亚系列相似。
