Comparison of clinical effects of endoscopic submucosal dissection and endoscopic mucosal resection in the treatment of elderly patients with early gastric cancer
10.3760/cma.j.cn115455-20230407-00344
- VernacularTitle:内镜黏膜下剥离术与内镜下黏膜切除术治疗老年早期胃癌的临床效果比较
- Author:
Xiaobei ZHU
1
;
Zheng CHEN
;
Yanhua HUANG
Author Information
1. 解放军联勤保障部队第九二三医院门诊部，南宁 530021
- Keywords:
Stomach neoplasms;
Neoplasm metastasis;
Endoscopic mucosal resection;
Endoscopic submucosal dissection;
Aged
- From:
Chinese Journal of Postgraduates of Medicine
2024;47(6):531-535
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical efficacy of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in the treatment of elderly patients with early gastric cancer.Methods:Ninety-two elderly patients with early gastric cancer admitted to the 923th Hospital of the Joint Service Support Force of PLA from June 2019 to February 2022 were enrolled, and they were divided into ESD group (60 cases) and EMR group (32 cases) according to different surgical methods. The ESD group was treated with ESD surgery, while the EMR group was treated with EMR surgery. The short-term clinical efficacy of the two groups was compared. The gastric function including pepsinogen Ⅰ(PGⅠ), pepsinogenⅡ(PGⅡ), PGⅠ /PGⅡ ratio and the tumor markers including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), and invasion genes within the lesion including vascular endothelial growth factor C (VEGF-C), E-cadherin, microtubule depolymerin (Stathmin), Krüppel like factor 4 (KLF4) were detected before and 3 d after surgery. Followed up for 1 year, the recurrence rate and complications between the two groups were compared.Results:All of 92 patients successfully removed the diseased tissue as a whole, and the R0 and R1 resection rate between the two groups had no statistical differences ( P>0.05). At 3 d after surgery, the levels of PG Ⅰand PGⅠ/PG Ⅱin the both groups were higher than those before surgery, and the level of PG Ⅱ in the both groups was lower than that before surgery; the levels of PG Ⅰand PGⅠ/PG Ⅱ in the ESD group were higher than those in the EMR group: (86.50 ± 8.23) μg/L vs. (77.47 ± 7.40) μg/L, 5.29 ± 0.54 vs. 3.65 ± 0.50; the level of PG Ⅱ ratio in the ESD group was lower than that in the EMR group: (16.34 ± 3.05) μg/L vs. (21.20 ± 3.27) μg/L, there were statistical differences ( P<0.05). At 3 d after surgery, the levels of CEA, CA19-9 and CA125 in the two groups were decreased, and the levels of the above indicators in the ESD group were lower than those in the EMR group: (2.42 ± 0.45) μg/L vs. (3.29 ± 0.40) μg/L, (8.55 ± 2.10) kU/L vs. (10.62 ± 2.76) kU/L, (13.75 ± 4.28) kU/L vs. (17.20 ± 4.90) kU/L, there were statistical differences ( P<0.05). At 3 d after surgery, the mRNA expression of E-cadherin and KLF4 in the two groups were increased, and the mRNA expression of VEGF-C, Stathmin in the two groups were decreased, and the mRNA expression of E-cadherin and KLF4 in the ESD group were lower than those in the EMR group: 2.89 ± 0.31 vs. 3.03 ± 0.21, 2.90 ± 0.28 vs. 3.12 ± 0.37, and the mRNA expression of VEGF-C, Stathmin in the ESD group were higher than those in the EMR group: 0.45 ± 0.11 vs. 0.41 ± 0.07, 0.52 ± 0.23 vs. 0.43 ± 0.09, there were statistical differences ( P<0.05). The complication rate in the ESD group was lower than that in the EMR group: 5.00%(3/60) vs. 23.33% (14/60) , there was statistical difference ( χ2 = 8.32, P<0.01). The recurrence rate in the 1-year between the two groups had no statistical difference ( P>0.05). Conclusions:Compared with EMR, ESD is effective in the treatment of elderly early gastric cancer, which can better correct the abnormal secretion of pepsinogen, promote the functional recovery of gastric cells and glands, reduce the level of serum tumor markers, inhibit the metastasis and proliferation of tumor cells, and has good safety.
