Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer
Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer
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DOI：
10.1055/s-0031-1291486
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发表时间：
2012-02-01
期刊：
影响因子：
9.3
通讯作者：
Igarashi, M.
中科院分区：
文献类型：
--
作者：
Okada, K.;Fujisaki, J.;Igarashi, M.
背景和研究目的：未分化型早期胃癌（UD-EGC）的内镜下粘膜下剥离术（ESD）在技术上是可行的;然而，该手术的长期临床结局尚未得到充分研究。我们的研究的目的是阐明长期的ESD为UD-EGC.Patients和方法的结果：2003年9月至2009年10月，共153例患者被诊断为内镜下具有UD-EGC满足扩大标准ESD。在获得知情同意后，选择101例患者接受ESD，52例患者接受外科手术。我们评估了101例首次接受ESD的连续患者的临床结局，这些患者有103处UD-EGC病变。结果：103例患者中，根治性切除率为82.5%（85/103），整体切除率为99.0%（102/103）。我们遇到了一个病人的淋巴结转移检测诊断ESD之前，计算机断层扫描，虽然根治性切除原发病灶的基础上实现常规组织学检查。在78例在过去5年内没有恶性肿瘤病史的患者中，原发病灶获得根治性切除，随访期间未观察到局部复发或远处转移;然而，2例患者（2.6%）在原发ESD后检测到1例同时性和2例异时性病灶。因此，在40.0个月的中位随访期内估计（范围19-92个月）和36.0个月3年和5年总死亡率分别为1.9%和3.9%，3年和5年总无病生存率均为96.7%。虽然我们的单中心回顾性研究可能被认为只是初步的，但我们的数据表明，ESD治疗UD-EGC可能会产生良好的长期结局。
Background and study aim: Endoscopic submucosal dissection (ESD) of undifferentiated-type early gastric cancer (UD-EGC) is technically feasible; however, the long-term clinical outcomes of the procedure have not yet been fully investigated. The aim of our study was to elucidate long-term outcomes of ESD for UD-EGC.Patients and methods: Between September 2003 and October 2009, a total of 153 patients were diagnosed endoscopically as having UD-EGC fulfilling the expanded criteria for ESD. After informed consent was obtained, 101 patients were selected to undergo ESD and 52 to undergo surgical operation. We assessed the clinical outcomes of ESD in 101 consecutive patients with 103 UD-EGC lesions who were undergoing ESD for the first time. The overall mortality and disease-free survival rates after ESD were evaluated as the long-term outcomes.Results: The rates of en bloc and curative resection were 99.0% (102/103) and 82.5% (85/103), respectively. We encountered one patient with nodal metastasis detected by computed tomography before diagnostic ESD, although curative resection of the primary lesion was achieved based on routine histological examination. Among the 78 patients without a past history of malignancy within the previous 5 years in whom curative resection of the primary lesion was achieved, no cases of local recurrence or distant metastasis were observed during follow-up; however, 1 synchronous and 2 metachronous lesions were detected in 2 patients (2.6%) after primary ESD. Thus, estimated over a median follow-up period of 40.0 months (range 19-92 months) and 36.0 months (range 9-92 months), the 3- and 5-year overall mortality rates were 1.9% and 3.9%, respectively, and the 3- and 5-year overall disease-free survival rates were both 96.7%.Conclusions: Although our single-center retrospective study may be considered to be only preliminary, our data indicate that ESD for UD-EGC may yield good long-term outcomes.