Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study

被引:578
作者
Isomoto, H. [1 ]
Shikuwa, S. [1 ]
Yamaguchi, N. [1 ]
Fukuda, E. [1 ]
Ikeda, K. [1 ]
Nishiyama, H. [1 ]
Ohnita, K. [1 ]
Mizuta, Y. [1 ]
Shiozawa, J. [1 ]
Kohno, S. [1 ]
机构
[1] Nagasaki Univ, Sch Med, Dept Internal Med 2, Nagasaki 8528501, Japan
关键词
MUCOSAL RESECTION; RECURRENCE; KNIFE;
D O I
10.1136/gut.2008.165381
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective: Endoscopic submucosal dissection (ESD) has the advantage over conventional endoscopic mucosa resection, permitting removal of early gastric cancer (EGC) en bloc, but long-term clinical outcomes remain unknown. A follow-up study on tumour recurrence and survival after ESD was conducted. Method: ESD was performed for patients with EGC that fulfilled the expanded criteria: mucosal cancer without ulcer findings irrespective of tumour size; mucosal cancer with ulcer findings <= 3 cm in diameter; and minute submucosal invasive cancer <= 3 cm in size. 551 patients with 589 EGC lesions were enrolled. The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 6-89 months (median, 30 months). The main outcome measures were resectability (en bloc or piecemeal resection), and curability (curative or non-curative). Complications were assessed, and factors related to each were analysed statistically. The overall and disease-free survival rates were estimated. Results: En bloc resection was achieved in 94.9% (559/589), and larger lesions were at higher risk of piecemeal resection. 550 of 581 lesions (94.7%) were deemed to have undergone curative resection. En bloc resection was the only significant contributor to curative ESD. Patients with non-curative resection developed local recurrence more frequently. The 5-year overall and disease-specific survival rates were 97.1% and 100%, respectively. Conclusion: Precise assessment of curability with successful one-piece resection may reduce tumour recurrence after ESD. The prognosis of EGC patients treated by ESD is likely to be excellent, though further longer follow-up studies are warranted.
引用
收藏
页码:331 / 336
页数:6
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