内镜黏膜下剥离术治疗 2 厘米以上未分化型早期胃癌并进行 R0 切除术的长期疗效

J. Bae, Chang-Beom Ryu, Moon Sung Lee, K. Dua
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摘要

背景 对局限于粘膜、大小超过 2 厘米的未分化型(UD 型)早期胃癌(ESC)进行内镜粘膜下剥离术(ESD)不仅具有挑战性,而且其长期疗效也不甚了解。目的 评估对局限于粘膜、大小超过 2 厘米的 UD 型 EGC 实施 ESD 治疗的长期疗效,并与病变小于 2 厘米的 EGC 进行比较。方法 回顾性分析一家三甲医院的 143 例经 ESD 组织学确诊的 UD 型 EGC 患者。排除了同步病变和不同步病变病例,以及一例在 ESD 后进行急诊手术的病例。共有 137 例病例入选。接受 R0 切除术的 79 例病例分为 2 厘米或以下(A 组)和 2 厘米以上(B 组)。结果 79 例接受 R0 切除术的患者中,A 组和 B 组的人数分别为 51 人和 28 人。平均随访时间(标清)为 79.71 ± 45.42 个月。A 组(1/51,2%)和 B 组(1/28,3.6%)分别有一名患者局部复发。A 组患者接受了手术治疗,而 B 组患者则反复接受了 ESD 治疗,均未再复发。两组患者均无区域淋巴结转移、远处转移和死亡。与扩大适应症相比,对超过2厘米的病灶采用ESD R0切除策略,20.4%(28/137)的患者可以避免手术。结论 如果通过ESD实现R0切除,在超过5年的随访中,2厘米以上的UD型EGC与2厘米以下的病变相比,也显示出良好且相似的临床预后。通过R0切除策略,一些患者可以避免手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term outcomes of endoscopic submucosal dissection for undifferentiated type early gastric cancer over 2 cm with R0 resection
BACKGROUND Endoscopic submucosal dissection (ESD) for over 2 cm in size undifferentiated type (UD type) early gastric cancer (EGC) confined to the mucosa is not only challenging, but also long-term outcomes are not well known. AIM To evaluate the long-term outcomes of ESD done for UD type EGCs confined to the mucosa over 2 cm in size and compare the results with those where the lesions were less than 2 cm. METHODS 143 patients with UD type EGC confirmed on histology after ESD at a tertiary hospital were reviewed. Cases with synchronous and metachronous lesions and a case with emergency surgery after ESD were excluded. A total of 137 cases were enrolled. 79 cases who underwent R0 resection were divided into 2 cm or less (group A) and over 2 cm (group B) in size. RESULTS Among 79 patients who underwent R0 resection, the number in group A and B were 51 and 28, respectively. The mean follow-up period (SD) was 79.71 ± 45.42 months. There was a local recurrence in group A (1/51, 2%) and group B (1/28, 3.6%) respectively. This patient in group A underwent surgery while the patient in group B underwent repeated ESD with no further recurrences in both patients. There was no regional lymph node metastasis, distant metastasis, and deaths in both groups. With R0 resection strategy for ESD on lesions over 2 cm, 20.4% (28/137) of patients were able to avoid surgery compared with expanded indication. CONCLUSION If R0 resection is achieved by ESD, UD type EGCs over 2 cm also showed good and similar clinical outcomes as compared to lesions less than 2 cm when followed for over 5 years. With R0 resection strategy, several patients can avoid surgery.
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