Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan.
Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
Gastric Cancer. 2022 Nov;25(6):1031-1038. doi: 10.1007/s10120-022-01323-8. Epub 2022 Jul 25.
As the indications for endoscopic submucosal dissection (ESD) for early gastric cancer have been revised, diagnostic ESD has increased. However, despite the technical difficulty of ESD for large lesions, the degree to which curative resection can be achieved has not been clarified. This study investigated the feasibility and safety of ESD for gastric lesions larger than 5 cm.
This retrospective multicenter study included 3474 gastric lesions treated by ESD from April 2012 to December 2021. We compared clinicopathological characteristics and treatment outcomes between lesions ≥ 5 cm and lesions < 5 cm.
There were 128 lesions in the ≥ 5 cm group and 3282 lesions in the < 5 cm group. In the ≥ 5 cm group, upper location and fibrosis during ESD were more common, with a lower rate of 0-IIc type. Both en bloc resection rate and R0 resection rate were comparable, but there was a difference in curative resection rate (65.6% in the ≥ 5 cm group and 91.5% in the < 5 cm group). The frequency of adverse events (post-ESD bleeding, perforation, or stenosis) was almost similar, but delayed perforation was significantly more common (1.6% in the ≥ 5 cm group vs. 0.1% in the < 5 cm group).
About two-thirds of curative resections were obtained with ESD for early gastric lesions larger than 5 cm, but delayed complications should be noted (Number: UMIN000047725).
随着内镜黏膜下剥离术（ESD）治疗早期胃癌适应证的修订，诊断性 ESD 有所增加。然而，尽管 ESD 治疗大病变存在技术难度，但尚未明确能够达到多大程度的治愈性切除。本研究旨在探讨治疗直径大于 5cm 的胃病变行 ESD 的可行性和安全性。
本回顾性多中心研究纳入了 2012 年 4 月至 2021 年 12 月期间接受 ESD 治疗的 3474 例胃病变患者。我们比较了病变直径≥5cm 组与病变直径<5cm 组的临床病理特征和治疗结局。
病变直径≥5cm 组中共有 128 例病变，病变直径<5cm 组中共有 3282 例病变。在病变直径≥5cm 组中，病变位于上部和 ESD 时出现纤维化更为常见，0-IIc 型的比例较低。整块切除率和 R0 切除率相当，但治愈性切除率存在差异（病变直径≥5cm 组为 65.6%，病变直径<5cm 组为 91.5%）。不良事件（ESD 后出血、穿孔或狭窄）的发生频率几乎相似，但延迟性穿孔更为常见（病变直径≥5cm 组为 1.6%，病变直径<5cm 组为 0.1%）。
对于直径大于 5cm 的早期胃癌病变，通过 ESD 获得约三分之二的治愈性切除，但应注意迟发性并发症（注册号：UMIN000047725）。
