What are the appropriate indications for endoscopic mucosal resection for early gastric cancer? Analysis of 256 endoscopically resected lesions.
What are the appropriate indications for endoscopic mucosal resection for early gastric cancer? Analysis of 256 endoscopically resected lesions.
复制标题
早期胃癌内镜下黏膜切除术的适宜适应症有哪些？
作者：
Mitsuki Miyata;Y. Yokoyama;N. Okoyama;Takashi Joh;K. Seno;Makoto Sasaki;H. Ohara;T. Nomura;K. Kasugai;M. Itoh
背景和研究目的
尽管无溃疡或无疤痕的早期胃癌(EGC)的内窥镜黏膜切除术(EMR)在日本已非常流行，并被认为是有益的，但EMR的治愈率仍低于手术切除。我们调查了在内窥镜下切除EGCs的患者，以确定影响EMR治愈率的因素。
患者和方法
我们回顾了1989-1998年间接受EMR的256个EGC病变，包括患者概况、肉眼类型、位置、肿瘤最大直径、切除方法和组织学分型。对患者的预后也进行了尽可能的调查。
结果
EGC EMR根治性全切除率为74.2%。对于影响可治愈性的因素，肿瘤大小(大于15 mm)、切除方法(分区切除)和组织学类型(低分化)对完全切除率有统计学意义的影响。对这些因素的多变量分析证实了这些结果。EMR后16例怀疑黏膜下侵犯，但进一步手术后仅1例发现黏膜下癌。有复发的患者，术后最长无复发时间为48个月，平均无复发时间为195.4天。
结论
对于EGC，EMR的合适指征被认为是黏膜内分化型腺癌，无溃疡或瘢痕形成，且无论肉眼类型，大小不超过15 mm。定期随访至少5年是必要的。
BACKGROUND AND STUDY AIMS
Although endoscopic mucosal resection (EMR) for early gastric cancer (EGC) without ulceration or scarring has been very popular in Japan and thought to be beneficial, curability by EMR is still lower than that for surgical resection. We investigated patients whose EGCs were resected endoscopically in order to identify the factors affecting curability by EMR.
PATIENTS AND METHODS
We investigated retrospectively 256 EGC lesions (251 patients) which were subjected to EMR between 1989 and 1998 with respect to patient profile, macroscopic type, location, maximum diameter of tumors, resection method and histological typing. The prognoses of the patients were also investigated as far as possible.
RESULTS
The curative total resection rate for EMR of EGC was 74.2 %. Concerning the factors affecting curability, the size of the lesion (over 15 mm), the method of resection (divisional resection), and histological typing (poorly differentiated) had a statistically significant effect on the complete resection rate. Multivariate analysis of the factors confirmed these results. Submucosal invasion was suspected in 16 patients after EMR, but submucosal cancer was found in only one patient after further surgery. Where there was recurrence, the longest recurrence-free period after EMR of EGC was 48 months, whereas the mean recurrence-free period was 195.4 days.
CONCLUSIONS
The appropriate indication for EMR for EGC is thought to be an intramucosal differentiated-type adenocarcinoma without ulceration or scarring, and no more than 15 mm in size regardless of macroscopic type. Periodic follow-up for at least 5 years is necessary.