Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer
Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer
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DOI：
10.1055/s-0034-1392249
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发表时间：
2015-09-01
期刊：
影响因子：
9.3
通讯作者：
Kim, Jae J.
中科院分区：
文献类型：
--
作者：
Min, Byung-Hoon;Kim, Eun Ran;Kim, Jae J.
背景和研究目的：建议一个适当的监测策略后，根治性内镜粘膜下剥离术（ESD）的早期胃癌，发病率和模式的基础上，局部，异时，和extragastric revolution.Patients和方法：2003年和2011年之间，1497例连续患者1539分化型早期胃癌符合绝对或扩大的适应症标准进行根治性ESD。在标准化的监测方案下，对他们进行了食管-胃镜检查（EGD）和腹部计算机断层扫描（CT）随访。结果：1年内发现残留病灶和同步病灶的发生率分别为0.13%和0.87%。在中位47个月的随访期间，有1例局部复发（0.08%;早期胃癌）和47例异时复发（3.6%; 44例早期胃癌，3例pT 2晚期胃癌）;所有患者均接受了治愈性治疗。在5年的监测中，异时复发的累积发生率曲线呈线性增加。从ESD到异时复发的中位时间为30个月。在绝对和扩展适应症的根治性ESD后，分别在5年和4年时有2例胃外淋巴结复发（0.15%）。扩大适应症的患者进行了姑息性手术，死于胃癌progression.Conclusions：有一个恒定的发病率异时复发在5年的监测期间，有至少4年后，早期胃癌ESD的绝对适应症胃外复发。因此，在早期胃癌根治性ESD后至少5年内，每年或每两年监测EGD和腹部CT可能是必要的，绝对和扩大的适应症。
Background and study aims: To suggest an appropriate surveillance strategy after curative endoscopic submucosal dissection (ESD) for early gastric cancers, based on incidence and patterns of local, metachronous, and extragastric recurrence.Patients and methods: Between 2003 and 2011, 1497 consecutive patients with 1539 differentiated-type early gastric cancers meeting absolute or expanded indication criteria underwent curative ESD. They were followed up with esophago-gastroduodenoscopy (EGD) and abdominal computed tomography (CT) under a standardized surveillance protocol. Long-term outcomes were analyzed for 1306 patients with at least 1 year's follow-up.Results: Incidences of residual and synchronous lesions detected within 1 year were 0.13% and 0.87 %, respectively. During median 47 months of follow-up, there was 1 local recurrence (0.08 %; early gastric cancer) and 47 cases of metachronous recurrence (3.6 %; 44 early gastric cancers, 3 pT2 advanced gastric cancers); all were curatively treated. During a 5-year surveillance, the cumulative incidence curve of metachronous recurrence increased linearly. Median time from ESD to metachronous recurrence was 30 months. There were 2 extragastric recurrences (0.15 %) in lymph nodes, at 5 and 4 years, respectively, after curative ESD for absolute and expanded indications. The patient with the expanded indications underwent a palliative operation and died of gastric cancer progression.Conclusions: There was a constant incidence rate of metachronous recurrence during a 5-year surveillance period and there was extragastric recurrence at least 4 years after ESD of early gastric cancer even for absolute indications. Therefore, annual or biannual surveillance EGD and abdominal CT might be necessary for at least 5 years after curative ESD for early gastric cancers, with absolute as well as expanded indications.