Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, South Korea.
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Int J Surg. 2020 Aug;80:124-128. doi: 10.1016/j.ijsu.2020.06.041. Epub 2020 Jul 2.
This study aimed to evaluate the operative safety and long-term outcomes of additional curative gastrectomy (ACG) after non-curative endoscopic submucosal dissection (ESD), as compared with standard gastrectomy (SG) without ESD in patients with early gastric cancer.
Data from 101 patients receiving ACG after non-curative ESD (Post-ESD group) and 1080 patients after SG without ESD (Surgery-only group), between 2009 and 2016, were reviewed retrospectively. Clinicopathologic characteristics, overall survival (OS), disease-specific survival (DSS), and relapse-free survival (RFS) were compared between groups, using propensity score matching analysis.
After propensity score matching, a total of 101 patients in the post-ESD group and 202 patients in the surgery-only group were analyzed. The post-ESD group had shorter operation times than did the surgery-only group (p = 0.005). Estimated blood loss and the incidence of postoperative morbidity did not differ between the two groups, and no differences were observed in pathologic outcomes, including N stage (p = 0.268). In addition, 5-year OS, DSS, and RFS rates were not significantly different between groups (OS; 95.1% vs. 98.2%, p = 0.535, DSS; 98.2% vs. 98.7%, p = 0.956, and RFS; 98.6% vs. 98.9%, p = 0.757, respectively).
ACG can be performed safely after non-curative endoscopic submucosal dissection, with good operative outcomes.
本研究旨在评估内镜下黏膜剥离术（ESD）后非治愈性附加根治性胃切除术（ACG）与早期胃癌患者无 ESD 标准胃切除术（SG）相比的手术安全性和长期结果。
回顾性分析了 2009 年至 2016 年间接受非治愈性 ESD 后行 ACG（ESD 后组）的 101 例患者和无 ESD 行 SG（单纯手术组）的 1080 例患者的数据。采用倾向评分匹配分析比较两组患者的临床病理特征、总生存期（OS）、疾病特异性生存期（DSS）和无复发生存期（RFS）。
经倾向评分匹配后，ESD 后组共 101 例患者和单纯手术组 202 例患者纳入分析。ESD 后组的手术时间短于单纯手术组（p=0.005）。两组患者的估计出血量和术后发病率无差异，且病理结果包括 N 分期也无差异（p=0.268）。此外，两组患者的 5 年 OS、DSS 和 RFS 率无显著差异（OS：95.1% vs. 98.2%，p=0.535，DSS：98.2% vs. 98.7%，p=0.956，RFS：98.6% vs. 98.9%，p=0.757）。
非治愈性内镜下黏膜剥离术后行 ACG 是安全可行的，且手术效果良好。
