Long-term survival after endoscopic resection versus surgery in early gastric cancers
Long-term survival after endoscopic resection versus surgery in early gastric cancers
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DOI：
10.1055/s-0034-1391284
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发表时间：
2015-04-01
期刊：
影响因子：
9.3
通讯作者：
Kook, Myeong-Cheorl
中科院分区：
文献类型：
--
作者：
Kim, Young-Il;Kim, Young-Woo;Kook, Myeong-Cheorl
背景和研究目的：符合扩展适应症的早期胃癌内镜切除术被认为是一种研究性治疗。本研究的目的是评估内镜切除术与手术治疗符合扩大适应症的早期胃癌的长期结局。方法：我们回顾性分析了2001年至2009年接受内镜切除术或手术治疗符合扩大适应症的胃癌患者的数据。总生存率是主要结局，胃癌复发率和并发症发生率是次要outcome.Results：在457例患者中，165例接受内镜切除术和292例手术，中位随访时间为58.6个月。内镜切除术和外科手术的5年总生存率分别为97.5%和97.0%; Kaplan-Meier分析显示无显著差异（P= 0.425）。内镜切除术的5年胃癌复发率高于手术（4.8% vs. 0.3%; P< 0.001），主要是因为仅在内镜切除术组中发生的异时性癌（9/165，5.5%）。大部分异时性癌（88.9%）经内镜下切除治愈.两组的早期并发症发生率相似（P= 0.557），但根据Clavien-Dindo分类，内镜切除组的III级或更高级别并发症多于手术组（4.8% vs. 1.4%，P= 0.026）。晚期并发症仅发生在手术后（4.8%，P= 0.004），和大多数（92.9%）是III级或higher.Conclusions：内镜切除术可能是一个最佳的替代手术胃癌，符合扩大的适应症标准，因为一个可比的长期总生存率。
Background and study aim: Endoscopic resection for early gastric cancers that meet the expanded indication is considered to be an investigational treatment. The study aim was to evaluate long-term outcomes of endoscopic resection compared with surgery for early gastric cancers meeting the expanded indication.Methods: We retrospectively reviewed data from patients who underwent endoscopic resection or surgery for gastric cancers meeting the expanded indication between 2001 and 2009. Overall survival rate was the primary outcome; gastric cancer recurrence rates and complication rates were secondary outcomes.Results: Among 457 patients included, 165 underwent endoscopic resection and 292 surgery, with median follow-up duration of 58.6 months. The 5-year overall survival rates were 97.5% and 97.0% for endoscopic resection and surgery, respectively; Kaplan-Meier analysis showed no significant difference (P= 0.425). The 5-year gastric cancer recurrence rate was higher for endoscopic resection than for surgery (4.8% vs. 0.3 %; P< 0.001) mainly because of metachronous cancers which developed only in the endoscopic resection group (9/165, 5.5 %). Most of the metachronous cancers (88.9 %) were curatively treated with endoscopic resection. Early complication rates were similar between the groups (P= 0.557), but the endoscopic resection group had more grade III or higher complications according to the Clavien-Dindo classification compared with the surgery group (4.8% vs. 1.4 %, P= 0.026). Late complications occurred only following surgery (4.8 %, P= 0.004), and most (92.9 %) were grade III or higher.Conclusions: Endoscopic resection may be an optimal alternative to surgery for gastric cancers that meet the expanded indication criteria, because of a comparable long-term overall survival rate.