Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Saudi J Gastroenterol. 2021 Mar-Apr;27(2):97-104. doi: 10.4103/sjg.SJG_403_20.
The curative criteria after endoscopic submucosal dissection for early gastric carcinoma were updated by the Japanese Gastric Cancer Association. No study has shown promising results with endoscopic submucosal dissection for early adenocarcinoma of esophagogastric junction based on the new curative criteria. The purpose of this study was to validate clinical efficacy of the application of the curative criteria of the 5th edition Japanese gastric cancer treatment guidelines for early adenocarcinoma of esophagogastric junction after endoscopic submucosal dissection.
Patients who underwent endoscopic submucosal dissection for Siewert type II adenocarcinoma between January 2013 and June 2018 were eligible for this study. Clinical and pathological features and treatment outcomes were retrospectively reviewed using medical records.
The success rate for en-bloc resection was 97.2% (172/177) and the curative resection rate was 71.2% (126/177). Additional endoscopic submucosal dissection or radical surgery was conducted in 10 patients (5.6%) who did not fulfil the curative resection criteria, while one patient with curative resection remedied with endoscopic submucosal dissection because of recurrence. According to eCura scoring system, 94 patients (53.1%) were categorized into eCura A, 34 patients (19.2%) into eCura B, 11 patients (6.2%) into eCura C-1, and 38 patients (21.5%) into eCura C-2. Five patients categorized as eCura C-2 underwent radical surgery, two of whom have lymph node metastasis.
Endoscopic submucosal dissection for early adenocarcinoma of esophagogastric junction that met the expanded criteria of the 5th edition Japanese gastric cancer treatment guidelines were acceptable and should be the standard treatment instead of surgical resection.
日本胃癌协会更新了内镜黏膜下剥离术治疗早期胃癌的疗效标准。基于新的疗效标准，尚无研究显示内镜黏膜下剥离术治疗胃食管结合部早期腺癌具有良好的效果。本研究旨在验证第 5 版日本胃癌治疗指南中应用疗效标准治疗胃食管结合部早期腺癌的临床疗效。
本研究纳入了 2013 年 1 月至 2018 年 6 月间接受内镜黏膜下剥离术治疗 Siewert Ⅱ型腺癌的患者。通过病历回顾性分析了患者的临床病理特征和治疗结果。
整块切除成功率为 97.2%（172/177），完全切除率为 71.2%（126/177）。10 例（5.6%）未达到完全切除标准的患者接受了额外的内镜黏膜下剥离术或根治性手术，而 1 例完全切除的患者因复发而接受了内镜黏膜下剥离术补救治疗。根据 eCura 评分系统，94 例（53.1%）患者为 eCura A，34 例（19.2%）患者为 eCura B，11 例（6.2%）患者为 eCura C-1，38 例（21.5%）患者为 eCura C-2。5 例 eCura C-2 患者接受了根治性手术，其中 2 例有淋巴结转移。
符合第 5 版日本胃癌治疗指南扩大标准的内镜黏膜下剥离术治疗胃食管结合部早期腺癌是可行的，应作为标准治疗方法，而非手术切除。
