Endoscopic mucosal resection for treatment of early gastric cancer
Endoscopic mucosal resection for treatment of early gastric cancer
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DOI：
10.1136/gut.48.2.225
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发表时间：
2001-02-01
期刊：
影响因子：
24.5
通讯作者：
Yoshida, S
中科院分区：
文献类型：
--
作者：
Ono, H;Kondo, H;Yoshida, S
背景：在日本，内镜下粘膜切除术（EMR）被认为是早期胃癌（EGC）的一种治疗选择，因为早期胃癌淋巴结转移的可能性很低。本文介绍了东京国立癌症中心医院11年来EGC的EMR结果。方法：emr应用于直径不超过30mm的早期癌症患者，这些患者具有良好或中度组织学分化类型，表面升高和/或降低（I型，IIa型和IIc型），但没有溃疡或明确的粘膜下浸润迹象。切除的标本每隔2毫米进行连续切片仔细检查，如果组织病理学显示粘膜下浸润和/或血管受累，或者切除边缘不清楚，建议手术。结果：1987 ~ 1998年，445例患者中479例接受EMR治疗，其中74例病理检查发现粘膜下浸润。69%的粘膜内癌（278/405）被切除，边缘明显。在127例没有“完全切除”的癌症中，14例接受了额外的手术，9例接受了内窥镜治疗；17例胃局部复发，1例经内镜治疗，5例经完全切除。所有肿瘤均通过随访内镜诊断并随后进行手术治疗。中位随访期为38个月（3-120个月），无胃癌相关死亡。出血和穿孔（5%）是EMR的两个主要并发症，但没有与治疗相关的死亡。结论：根据我们的经验，EMR使我们能够在不牺牲治愈可能性的情况下进行侵入性较小的治疗。
Backgroud-In Japan, endoscopic mucosal resection (EMR) is accepted as a treatment option for cases of early gastric cancer (EGC) where the probability of lymph node metastasis is low. The results of EMR for EGC at the National Cancer Center Hospital, Tokyo, over a 11 year period are presented.Methods-EMR was applied to patients with early cancers up to 30 mm in diameter that were of a well or moderately histologically differentiated type, and were superficially elevated and/or depressed (types I, IIa, and IIc) but without ulceration or definite signs of submucosal invasion. The resected specimens were carefully examined by serial sections at 2 mm intervals, and if histopathology revealed submucosal invasion and/or vessel involvement or if the resection margin was not clear, surgery was recommended.Results-Four hundred and seventy nine cancers in 445 patients were treated by EMR from 1987 to 1998 but submucosal invasion was found on subsequent pathological examination in 74 tumours. Sixty nine percent of intramucosal cancers (278/405) were resected with a clear margin. Of 127 cancers without "complete resection", 14 underwent an additional operation and nine were treated endoscopically; the remainder had intensive follow up, Local recurrence in the stomach occurred in 17 lesions followed conservatively, in one lesion treated endoscopically, and in five lesions with complete resection. All tumours were diagnosed by follow up endoscopy and subsequently treated by surgery. There were no gastric cancer related deaths during a median follow up period of 38 months (3-120 months). Bleeding and perforation (5%) were two major complications of EMR but there were no treatment related deaths.Conclusion-In our experience, EMR allows us to perform less invasive treatment without sacrificing the possibility of cure.