Clinical impact of a strategy involving endoscopic submucosal dissection for early gastric cancer: determining the optimal pathway
Clinical impact of a strategy involving endoscopic submucosal dissection for early gastric cancer: determining the optimal pathway
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DOI：
10.1007/s10120-011-0008-6
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发表时间：
2011-03-01
期刊：
影响因子：
7.4
通讯作者：
Gotoda, Takuji
中科院分区：
文献类型：
--
作者：
Nonaka, Satoru;Oda, Ichiro;Gotoda, Takuji
内窥镜黏膜下剥离(ESD)是一种发展起来的技术，它能够对以前使用传统的内窥镜黏膜切除术(EMR)无法切除的大型溃疡性肿瘤性病变进行内窥镜切除(ER)。我们调查了引入ESD前后早期胃癌ER的临床结果，特别关注手术及其潜在后果。我们回顾了1990至2005年间连续2,785例早期胃癌手术患者和2,469例连续接受ER治疗的病变。这项研究分为EMR阶段(1990-1999年)和可持续发展阶段(2000-2005)。我们分析了内窥镜手术和手术切除的临床结果，并将“潜在可避免手术”定义为对可通过ER治愈的病变进行手术的病例。潜在可避免手术的比率在急诊期为3.8%(52/1,369)，在急诊期为0.2%(3/1,416)(P<；0.001)。对于ER患者，EMR组和ESD组未治愈ER的发生率分别为36.9%和17.0%(P<；0.001)。对于被定义为“仅具有阳性或难以估计水平边缘”的病变，ER无效的比率显著下降，从EMR组的26.1%(109/417)降至ESD组的1.4%(29/2052)(P<；0.001)。相反，ESD组被定义为“可能有淋巴结转移”的病变的未治愈ER率(15.5%；319/2,052)显著高于EMR组(10.8%；45/417)(P<；0.01)。ESD通路的应用显著降低了潜在可避免手术的比率，突出了实施ESD的相关优势。
Endoscopic submucosal dissection (ESD) is a technique developed to enable the endoscopic resection (ER) of large and ulcerative neoplastic lesions that were previously unresectable using conventional endoscopic mucosal resection (EMR). We investigated the clinical outcomes of ER of early gastric cancer (EGC) before and after the introduction of ESD, with particular attention to surgery and its potential consequences.We reviewed 2,785 consecutive surgical patients with EGC and 2,469 consecutive lesions treated by ER with curative intent between 1990 and 2005. The study was divided into an EMR period (1990-1999) and an ESD period (2000-2005). We analyzed the clinical outcomes of endoscopic and surgical resections and defined 'potentially avoidable surgery' as cases of surgery performed for lesions curable by ER.The rate of potentially avoidable surgery was 3.8% (52/1,369) in the EMR period and 0.2% (3/1,416) in the ESD period (P < 0.001). For ER patients, the rate of overall non-curative ER was 36.9% (154/417) in the EMR group and 17.0% (348/2,052) in the ESD group (P < 0.001). The rate of non-curative ER for lesions defined as having 'positive or difficult to estimate horizontal margins only' decreased significantly, from 26.1% (109/417) in the EMR group to 1.4% (29/2,052) in the ESD group (P < 0.001). Conversely, the rate of non-curative ER for lesions defined as having 'possible lymph node metastasis' significantly increased in the ESD group (15.5%; 319/2,052) compared to that in the EMR group (10.8%; 45/417) (P < 0.01).The application of a pathway involving ESD resulted in a significant decrease in the rate of potentially avoidable surgery, highlighting the advantages associated with performing ESD.