Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience
Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience
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DOI：
10.1007/s00464-010-1060-8
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发表时间：
2010-11-01
影响因子：
3.1
通讯作者：
Lee, Yong Chan
中科院分区：
文献类型：
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作者：
Park, Jun Chul;Lee, Sang Kil;Lee, Yong Chan
对于无淋巴结转移的早期胃癌(EGC)，内窥镜切除是公认的主要治疗方法。一种新的和改进的技术，内窥镜黏膜下剥离(ESD)，可能被证明是更有效的；然而，不完全切除和局部复发仍然是令人担忧的问题。本研究从2002年1月至2008年1月共收治239例EGC患者，其中50例EGC病变采用传统的胃镜下黏膜切除术(EMR组)，189例EGC病变采用ESD治疗(ESD组)。随访期间(平均30.3个月)，EMR组肿瘤整块切除率为86.8%(16 4/189)，ESD组为79.9%(15 1/189)，EMR组肿瘤整块切除率为60%(30/50)，EMR组为60%(30/50)。我们观察到ESD组有7例局部复发，但只有1例经ESD完全切除后局部复发。EMR组的复发率明显高于ESD组(分别为18%和3.7%，p<；0.001)。不完全切除显著增加了局部复发风险，较大的肿瘤大小和使用EMR增加了不完全切除的风险。大多数肿瘤(3/4)在初次复发时采用了额外的Ar等离子凝固术治疗后复发。尽管ESD治疗EGC有潜在的优势，但局部复发的风险仍然存在。所有接受EMR治疗的患者，即使是根治性切除，以及ESD后不完全切除的患者，都需要认真监测局部复发。此外，还需要进行一项大型前瞻性研究，以确定局部复发的最佳治疗方式。
Endoscopic resection is widely accepted as the primary treatment for early gastric cancer (EGC) without lymph node metastasis. A new and refined technique, endoscopic submucosal dissection (ESD), may prove to be more effective; however, incomplete resection and local recurrence present ongoing concerns. We sought to determine the clinicopathological features associated with local recurrence in patients with EGC following endoscopic resection.We enrolled in this study 239 EGC patients treated by endoscopic resection between January 2002 and January 2008.Fifty EGC lesions were treated by conventional endoscopic mucosal resection (EMR group) and 189 EGC lesions were treated by ESD (ESD group). During the follow-up period (mean = 30.3 months), the rates for en bloc resection and complete resection (defined as en bloc resection with negative resection margin) were 64% (32/50) and 60% (30/50), respectively, in the EMR group, and 86.8% (164/189) and 79.9% (151/189), respectively, in the ESD group. We observed seven local recurrences in the ESD group, though only one with complete resection by ESD had a local recurrence. The EMR group showed a significantly higher recurrence rate than did the ESD group (18% vs. 3.7%, respectively, p < 0.001). Incomplete resection significantly increased local recurrence risk, and larger tumor size and use of EMR increased the risk for incomplete resection. Most lesions (3/4) treated with additional argon plasma coagulation for an initial recurrence had recurred again.Despite the potential advantages in treating EGC with ESD, a risk for local recurrence remains. All patients treated with EMR, even with curative resection, and those with incomplete resection after ESD require conscientious surveillance for local recurrence. Furthermore, a large prospective study will be required to determine the best treatment modality for local recurrence.