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胃癌内镜治疗的疗效标准。

Curative criteria for endoscopic treatment of gastric cancer.

机构信息

Department of Gastroenterology, Centro Hospitalar Universitário Do Algarve, Portimão, Portugal.

Department of Gastroenterology, Hospital de Mérida, Badajoz, Spain.

出版信息

Best Pract Res Clin Gastroenterol. 2024 Feb;68:101884. doi: 10.1016/j.bpg.2024.101884. Epub 2024 Feb 3.

Abstract

Endoscopic treatment, particularly endoscopic submucosal dissection, has become the primary treatment for early gastric cancer. A comprehensive optical assessment, including white light endoscopy, image-enhanced endoscopy, and magnification, are the cornerstones for clinical staging and determining the resectability of lesions. This paper discusses factors that influence the indication for endoscopic resection and the likelihood of achieving a curative resection. Our review stresses the critical need for interpreting the histopathological report in accordance with clinical guidelines and the imperative of tailoring decisions based on the patients' and lesions' characteristics and preferences. Moreover, we offer guidance on managing complex scenarios, such as those involving non-curative resection. Finally, we identify future research avenues, including the role of artificial intelligence in estimating the depth of invasion and the urgent need to refine predictive scores for lymph node metastasis and metachronous lesions.

摘要

内镜治疗,特别是内镜黏膜下剥离术,已成为早期胃癌的主要治疗方法。全面的光学评估,包括白光内镜、图像增强内镜和放大,是临床分期和确定病变可切除性的基石。本文讨论了影响内镜切除适应证和实现治愈性切除可能性的因素。我们的综述强调了根据临床指南解读病理报告的重要性,以及根据患者和病变的特点和偏好做出决策的必要性。此外,我们还提供了处理复杂情况的指导,例如涉及非治愈性切除的情况。最后,我们确定了未来的研究方向,包括人工智能在估计浸润深度中的作用,以及迫切需要改进预测淋巴结转移和异时性病变的评分。

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