内镜黏膜下剥离术治疗早期胃食管结合部癌的短期疗效分析
|
摘要
目的探讨内镜切除治疗早期胃食管结合部癌的安全性和有效性。方法收集安徽医科大学第一附属医院2016年4月—2018年10月收治的行内镜黏膜下剥离术(ESD)治疗的早期胃食管结合部癌患者共166例,记录患者的性别、年龄、ESD治疗过程、术后病理、追加手术治疗情况以及术后随访资料。结合病理结果,分别按早期胃癌内镜下切除的适应证分类、eCrua评分系统进行淋巴结转移风险评估。结果 166例早期胃食管结合部癌患者中ESD术后治愈性切除146例(88.0%);非治愈性切除20例(12.0%),其中9例追加手术治疗。非治愈性切除组中病变直径>30 mm、合并溃疡、未分化型患者比例高于治愈性切除组(P<0.05)。患者术后平均随访15.7(3～33)个月,期间1例出现复发,无胃癌相关死亡病例。术后eCura C级共4例,2例局部有肿瘤残留,1例淋巴结转移。结论对于符合治疗适应证的早期胃食管结合部癌,ESD治疗是安全、有效的。术后结合病理结果对患者进行eCura评分可以较好地评估其淋巴结转移的风险。
Objective To evaluate the safety and short-term outcomes of endoscopic resection in the treatment of early adenocarcinoma of gastroesophageal junction.MethodsA total of 166 patients with early adenocarcinoma of gastroesophageal junction were treated by endoscopic submucosal dissection(ESD) from April 2016 to October 2018 in the First Affiliated Hospital of Anhui Medical University. The clinical information, including gender, age, the process of ESD treatment, post-operative pathology and additional surgical treatment were recorded. The risk assessment of lymph node metastasis was carried out according to the indications of eCrua scoring system and scores of endoscopic resection of early gastric cancer respectively.ResultsAmong the 166 patients with early adenocarcinoma of gastroesophageal junction, 146(88.0%) were cured after ESD, 20 cases(12.0%) were non-curable resection, 9 cases(5.4%) were transferred to perform additional operation. In the non-curable resection group, the proportion of patients with lesion diameter > 30 mm, lesions with ulcer or undifferentiated type was significantly higher than that in the curable resection group(P<0.05). The average postoperative follow-up time was 15.7 months(3-33 months). During the follow-up period, 1 case showed recurrence and no case of death associated with gastric cancer. After operation, there were 4 cases of eCura C, 2 cases of local residual tumors and 1 case of lymph node metastasis.ConclusionESD is safe and effective for the treatment of early adenocarcinoma of gastroesophageal junction. The risk of lymph node metastasis can be well assessed by eCura score system according to the postoperative pathological results.
Objective To evaluate the safety and short-term outcomes of endoscopic resection in the treatment of early adenocarcinoma of gastroesophageal junction.MethodsA total of 166 patients with early adenocarcinoma of gastroesophageal junction were treated by endoscopic submucosal dissection(ESD) from April 2016 to October 2018 in the First Affiliated Hospital of Anhui Medical University. The clinical information, including gender, age, the process of ESD treatment, post-operative pathology and additional surgical treatment were recorded. The risk assessment of lymph node metastasis was carried out according to the indications of eCrua scoring system and scores of endoscopic resection of early gastric cancer respectively.ResultsAmong the 166 patients with early adenocarcinoma of gastroesophageal junction, 146(88.0%) were cured after ESD, 20 cases(12.0%) were non-curable resection, 9 cases(5.4%) were transferred to perform additional operation. In the non-curable resection group, the proportion of patients with lesion diameter > 30 mm, lesions with ulcer or undifferentiated type was significantly higher than that in the curable resection group(P<0.05). The average postoperative follow-up time was 15.7 months(3-33 months). During the follow-up period, 1 case showed recurrence and no case of death associated with gastric cancer. After operation, there were 4 cases of eCura C, 2 cases of local residual tumors and 1 case of lymph node metastasis.ConclusionESD is safe and effective for the treatment of early adenocarcinoma of gastroesophageal junction. The risk of lymph node metastasis can be well assessed by eCura score system according to the postoperative pathological results.
引文
[1]邵大川,钱军.食管胃结合部腺癌的诊治现状及研究进展[J].中华全科医学,2014,12(9):1469-1471.Shao DC,Qian J.Current status and research progress of diagnosis and treatment of adenocarcinoma of esophagogastric junction[J].Chinese Journal of General Practice,2014,12(9):1469-1471.doi:10.16766/j.cnki.issn.1674-4152.2014.09.061.
[2]2015安徽省肿瘤登记年报[M].合肥:安徽省疾病预防控制中心,2015:39-41.Annual report of Anhui cancer registration 2015[M].Hefei:Center for Disease Control and Prevention,Anhui Province,2015:39-41.
[3]Bai JG,Lv Y,Dang CX.Adenocarcinoma of the esophagogastric junction in China according to Siewert’s classification[J].Jpn JClin Oncol,2006,36(6):364-367.doi:10.1093/jjco/hyl042.
[4]李德关,李永翔.食管胃结合部腺癌的手术治疗进展[J].安徽医学,2014,35(6):854-857.Li DG,Li YX.Progress in surgical treatment of adenocarcinoma of the esophagogastric junction[J].Anhui Medical Journal,2014,35(6):854-857.
[5]Endoscopic Classification Review Group.Update on the paris classification of superficial neoplastic lesions in the digestive tract[J].Endoscopy,2005,37(6):570-578.doi:10.1055/s-2005-861352.
[6]Japanese Gastric Cancer Association.Japanese classification of gastric carcinoma-2nd english edition[J].Gastric Cancer,1998,1(1):10-24.
[7]柴宁莉,翟亚奇、杜晨,等.早期胃癌内镜下规范化切除的专家共识意见[J/CD].中华胃肠内镜电子杂志,2018,5(2):49-60.Chai NL,Zhai YQ,Du C.et al.Expert consensus on standardized endoscopic resection of early gastric cancer[J/CD].Chin JGastrointestinal Endoscopy(Electronic Edition),2018,5(2):49-60.
[8]Hatta W,Gotoda T,Oyama T,et al.A Scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer:“eCura system”[J].Am J Gastroenterol,2017,112(6):874-881.doi:10.1038/ajg.95.
[9]Kawahara Y,Takenaka R,Okada H,et al.Endoscopic submucosal dissection using mucosectome for adenocarcinoma of esophagogastric junction and gastric cardia[J].Gastrointestinal Endoscopy,2008,67(5):178.
[10]Facciorusso A,Antonino M,Di Maso M,et al.Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer:A meta-analysis[J].World J Gastrointest Endosc,2014,6(11):555-563.doi:10.4253/wjge.v6.i11.555.
[11]李宗先,丁百静,李生,等.56例早期胃癌患者临床病理特征及诊治[J].皖南医学院学报,2018;37(2):130-133.Li ZX,Ding BJ,Li S,et al.56 patients with early gastric cancer:clinicopathological features,diagnosis and treatment[J].Journal of Southern Anhui Medical College,2018,37(2):130-133.doi:10.3969/j.issn.10020217.2018.02.009.
[12]Yang HJ,Kim SG,Lim JH,et al.Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer[J].Surg Endosc,2015,29(5):1145-1155.doi:10.1007/s00464-014-3780-7.
[13]Kim ER,Lee H,Min BH,et al.Effect of rescue surgery after noncurative endoscopic resection of early gastric cancer[J].BJS,2015,102(11):1394-1401.doi:10.1002/bjs.9873.
[14]Hatta W,Gotoda T,Oyama T,et al.Is the e Cura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer?Acomparative study[J].Gastric Cancer,2018,21(3):481-489.doi:10.1007/s10120-017-0769-7.
[15]NiwaIH,Ozawa1 R,Kurahashi1 Y,et al.The eCura system as a novel indicator for the necessity of salvage surgery after noncurative ESD for gastric cancer:A case-control study[J].PLoS One,2018,13(10):e0204039.doi:10.1371/journal.pone.0204039.
[2]2015安徽省肿瘤登记年报[M].合肥:安徽省疾病预防控制中心,2015:39-41.Annual report of Anhui cancer registration 2015[M].Hefei:Center for Disease Control and Prevention,Anhui Province,2015:39-41.
[3]Bai JG,Lv Y,Dang CX.Adenocarcinoma of the esophagogastric junction in China according to Siewert’s classification[J].Jpn JClin Oncol,2006,36(6):364-367.doi:10.1093/jjco/hyl042.
[4]李德关,李永翔.食管胃结合部腺癌的手术治疗进展[J].安徽医学,2014,35(6):854-857.Li DG,Li YX.Progress in surgical treatment of adenocarcinoma of the esophagogastric junction[J].Anhui Medical Journal,2014,35(6):854-857.
[5]Endoscopic Classification Review Group.Update on the paris classification of superficial neoplastic lesions in the digestive tract[J].Endoscopy,2005,37(6):570-578.doi:10.1055/s-2005-861352.
[6]Japanese Gastric Cancer Association.Japanese classification of gastric carcinoma-2nd english edition[J].Gastric Cancer,1998,1(1):10-24.
[7]柴宁莉,翟亚奇、杜晨,等.早期胃癌内镜下规范化切除的专家共识意见[J/CD].中华胃肠内镜电子杂志,2018,5(2):49-60.Chai NL,Zhai YQ,Du C.et al.Expert consensus on standardized endoscopic resection of early gastric cancer[J/CD].Chin JGastrointestinal Endoscopy(Electronic Edition),2018,5(2):49-60.
[8]Hatta W,Gotoda T,Oyama T,et al.A Scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer:“eCura system”[J].Am J Gastroenterol,2017,112(6):874-881.doi:10.1038/ajg.95.
[9]Kawahara Y,Takenaka R,Okada H,et al.Endoscopic submucosal dissection using mucosectome for adenocarcinoma of esophagogastric junction and gastric cardia[J].Gastrointestinal Endoscopy,2008,67(5):178.
[10]Facciorusso A,Antonino M,Di Maso M,et al.Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer:A meta-analysis[J].World J Gastrointest Endosc,2014,6(11):555-563.doi:10.4253/wjge.v6.i11.555.
[11]李宗先,丁百静,李生,等.56例早期胃癌患者临床病理特征及诊治[J].皖南医学院学报,2018;37(2):130-133.Li ZX,Ding BJ,Li S,et al.56 patients with early gastric cancer:clinicopathological features,diagnosis and treatment[J].Journal of Southern Anhui Medical College,2018,37(2):130-133.doi:10.3969/j.issn.10020217.2018.02.009.
[12]Yang HJ,Kim SG,Lim JH,et al.Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer[J].Surg Endosc,2015,29(5):1145-1155.doi:10.1007/s00464-014-3780-7.
[13]Kim ER,Lee H,Min BH,et al.Effect of rescue surgery after noncurative endoscopic resection of early gastric cancer[J].BJS,2015,102(11):1394-1401.doi:10.1002/bjs.9873.
[14]Hatta W,Gotoda T,Oyama T,et al.Is the e Cura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer?Acomparative study[J].Gastric Cancer,2018,21(3):481-489.doi:10.1007/s10120-017-0769-7.
[15]NiwaIH,Ozawa1 R,Kurahashi1 Y,et al.The eCura system as a novel indicator for the necessity of salvage surgery after noncurative ESD for gastric cancer:A case-control study[J].PLoS One,2018,13(10):e0204039.doi:10.1371/journal.pone.0204039.