Zhao Yun, Deng Zhongming, Li Hengping, Wang Yi, Zhang Wanli, Xiao Yong, Huang Jing
Department of General Surgery, Xiangyang No.1 People's Hospital, Affiliated Hospital of Hubei University of Medicine, Xiangyang 441000, China.
J BUON. 2019 Nov-Dec;24(6):2506-2513.
To compare the clinical efficacy and safety of endoscopic submucosal dissection (ESD) and laparoscopy-assisted radical gastrectomy (LARG) in the treatment of early gastric carcinoma (EGC) with different risks of lymph node metastasis.
The clinical data of 194 EGC patients who underwent ESD (ESD group, n=58) or LARG (LARG group, n=136) in our hospital from January 2014 to January 2016 were collected. The baseline data, pathological features of tumor, perioperative indexes and long- and short-term complications were compared between the two groups, the overall survival (OS) rate of patients was recorded through follow-up, and the tumor-free survival (TFS) rate was compared after ESD and LARG for EGC with different risks of lymph node metastasis.
The general clinical features were comparable between the two groups of patients, and there was no perioperative death. The pathological features of the tumor had no statistically significant differences between the two groups (p>0.05). The operation time in ESD group (73.57±21.30 min) was significantly shorter than that in LARG group (159.22±39.40 min) (p<0.001), and the time of first ambulation after operation in ESD group (1.6±0.8 d) was also overtly shorter than that in LARG group (3.5±1.7 d) (p<0.001). Postoperatively, no drainage tube was placed in the ESD group, while it was placed for 5.7±2.4 days on average in the LARG group. The time of first flatus after operation, time of first liquid diet after operation, and total hospitalization time in the ESD group were significantly compared with the LARG group (p<0.001). The incidence rate of short-term complications after surgery was 10.3% and 7.4% in the two groups, (p=0.570), while long-term complications were 17.6% (9/51) and 20.9% (24/115) in the two groups (p=0.631). The in situ tumor recurrence by the end of follow-up was 3.92% (2/51) and 0.87% (1/115) in the two groups, while the ectopic recurrence rate was 5.89% (3/51) and 0.87% (1/115) (p=0.173, p=0.087). OS survival was 96.1% (49/51) and 97.4% (112/115) in the two groups (p=0.751). The postoperative TFS of EGC patients with a low risk of lymph node metastasis was 93.8% (30/32) and 98.6% (70/71) in the two groups, again without significant difference (p=0.197). The postoperative TFS of EGC patients with a high risk of lymph node metastasis was 84.2% (16/19) and 97.7% (43/44) in the two groups, with statistically significant difference (log-rank, p=0.034).
ESD is characterized by small trauma, rapid postoperative recovery, postoperative recurrence and survival comparable to those after surgical operation and high safety for EGC with a low risk of lymph node metastasis. LARG can reduce the postoperative recurrence rate of EGC in patients with high risk of lymph node metastasis.
比较内镜黏膜下剥离术（ESD）与腹腔镜辅助根治性胃切除术（LARG）治疗不同淋巴结转移风险早期胃癌（EGC）的临床疗效及安全性。
收集2014年1月至2016年1月在我院接受ESD（ESD组，n = 58）或LARG（LARG组，n = 136）的194例EGC患者的临床资料。比较两组患者的基线数据、肿瘤病理特征、围手术期指标及近期和远期并发症，通过随访记录患者的总生存率（OS），并比较ESD和LARG术后不同淋巴结转移风险EGC患者的无瘤生存率（TFS）。
两组患者一般临床特征具有可比性，围手术期均无死亡。两组肿瘤病理特征差异无统计学意义（p>0.05）。ESD组手术时间（73.57±21.30分钟）明显短于LARG组（159.22±39.40分钟）（p<0.001），ESD组术后首次下床活动时间（1.6±0.8天）也明显短于LARG组（3.5±1.7天）（p<0.001）。术后ESD组未放置引流管，而LARG组平均放置5.7±2.4天。ESD组术后首次排气时间、首次进流食时间及总住院时间与LARG组相比差异有统计学意义（p<0.001）。两组术后近期并发症发生率分别为10.3%和7.4%，（p = 0.570），远期并发症发生率分别为17.6%（9/51）和20.9%（24/115）（p = 0.631）。随访末期两组原位肿瘤复发率分别为3.92%（2/51）和0.87%（1/115），而异位复发率分别为5.89%（3/51）和0.87%（1/115）（p = 0.173，p = 0.087）。两组OS生存率分别为96.1%（49/51）和97.4%（112/115）（p = 0.751）。两组淋巴结转移风险低的EGC患者术后TFS分别为93.8%（30/32）和98.6%（70/71），差异无统计学意义（p = 0.197）。两组淋巴结转移风险高的EGC患者术后TFS分别为84.2%（16/19）和97.7%（43/44），差异有统计学意义（log-rank，p = 0.034）。
ESD创伤小、术后恢复快，术后复发及生存情况与手术相当，对淋巴结转移风险低的EGC安全性高。LARG可降低淋巴结转移风险高的EGC患者术后复发率。
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