Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions.
Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions.
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DOI：
10.3892/etm.2015.2265
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发表时间：
2015-04
影响因子：
2.7
通讯作者：
Tomoda J
中科院分区：
文献类型：
--
作者：
Toyokawa T;Inaba T;Omote S;Okamoto A;Miyasaka R;Watanabe K;Izumikawa K;Fujita I;Horii J;Ishikawa S;Morikawa T;Murakami T;Tomoda J
虽然内镜黏膜下剥离术（ESD）后残留疾病和复发的频率已明显降低，但仍观察到少数ESD后残留疾病和复发的病例。本研究的目的是阐明非根治性切除的原因，并探讨危险因素。共调查了1，123例ESD治疗的早期胃肿瘤病变。非治愈性切除定义为切除边缘的组织学阳性、血管浸润或整体切除失败。非治愈性切除的病例被归类为三个原因之一：技术不足，术前误诊或组织学诊断的问题。分类后，根据一系列患者特征比较非治愈性和治愈性切除病例：手术时间、病变大小、类型和位置。非治愈性切除率为16%（182个病灶）。因手术技术不到位导致手术失败59例，术前误诊88例，组织学诊断有问题35例。多变量分析显示，较大的病变尺寸、较长的手术时间和经验不足的内镜医师与因技术不充分而导致的非治愈性切除的风险显著较高相关。此外，发现位于胃上部区域的病变和粘膜下浸润的癌症与由于术前误诊而导致的非治愈性切除的风险显著较高相关。总之，目前的研究表明，非根治性切除的主要原因是一个不适当的技术和术前误诊。这些问题的风险因素已得到澄清。
Although the frequency of residual disease and recurrence following endoscopic submucosal dissection (ESD) has markedly decreased, a few cases of residual disease and recurrence following ESD are still observed. The aims of the present study were to clarify the causes of non-curative resection and to investigate the risk factors. A total of 1,123 early gastric neoplasm lesions treated by ESD were investigated. Non-curative resection was defined as histological positivity of the resected margins, vascular invasion or failure of en bloc resection. Cases of non-curative resection were classified as being caused by one of three reasons: Inadequate technique, pre-procedural misdiagnosis or problems in the histological diagnosis. Following classification, the cases of non-curative and curative resection were compared based on a range of patient characteristics: Procedure time, and size, type and location of the lesions. The frequency of non-curative resection was 16% (182 lesions). Non-curative resection occurred due to inadequate technique in 59 cases, pre-procedural misdiagnosis in 88 cases and problems in the histological diagnosis in 35 cases. Multivariate analysis revealed that a large lesion size, long procedure time and inexperienced endoscopist were associated with a significantly higher risk of non-curative resection due to an inadequate technique. Furthermore, it was found that lesions located in the upper area of the stomach and cancer with submucosal invasion were associated with a significantly higher risk of non-curative resection due to pre-procedural misdiagnosis. In conclusion, the present study has shown that the major reasons for non-curative resection are an inadequate technique and pre-procedural misdiagnosis. The risk factors for these problems have been clarified.
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影响因子：
7.4
作者：
Nonaka, Satoru;Oda, Ichiro;Gotoda, Takuji
通讯作者：
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影响因子：
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影响因子：
4.1
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DOI：
10.1007/s00464-010-1060-8
发表时间：
2010-11-01
影响因子：
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