The therapeutic strategy after noncurative endoscopic submucosal dissection for early gastric cancer
10.3760/cma.j.issn.0253-3766.2019.11.012
- VernacularTitle: 早期胃癌非治愈性内镜黏膜下剥离术后的治疗策略研究
- Author:
Hong ZHOU
1
;
Chunguang GUO
1
;
Yingtai CHEN
1
;
Lizhou DOU
2
;
Yuemin ZHANG
2
;
Guiqi WANG
2
;
Dongbing ZHAO
1
Author Information
1. Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
2. Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Publication Type:Clinical Trail
- Keywords:
Gastric neoplasms;
Endoscopic submucosal dissection;
Lymph nodes metastasis;
Noncurative resection;
Radical resection
- From:
Chinese Journal of Oncology
2019;41(11):865-869
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the therapeutic strategy in patients with early gastric cancer after noncurative endoscopic submucosal dissection (ESD).
Methods:A total of 107 cases with early gastric cancer receiving noncurative endoscopic submucosal dissection were collected and the patients were classified into an additional gastrectomy group (n=41) and a simple follow-up group (n=66) according to the therapeutic method used after noncurative ESD. The clinicopathological information, short- and long-term clinical outcomes between the two groups were analyzed and compared.
Results:The mean age of the patients in the gastrectomy group and follow-up group was(59.2±8.7)years old and(64.7±8.8)years old, respectively. The depth of submucosal invasion was (1445.83±803.12) and (794.71±815.79) μm, respectively. The difference between the two groups was statistically significant (P=0.020 for age and P=0.010 for depth of submucosal invasion). Compared with follow-up group, the patients with undifferentiated histologic type, deep invasion of submucosa (SM2), diffuse type, lymphovascular invasion and neural invasion were more common in the gastrectomy group (P<0.05). The R0 resection rate of ESD in the gastrectomy group was significantly lower than the follow-up group(26.8% vs 65.2%, P<0.001). The positive residual tumor rate and LNM rate of additional gastrectomy group were 31.7%(13/41)and 9.76%(4/41)according to the pathological results after gastrectomy. The gastrectomy group had 2 cases of local recurrence (2/41, 4.9%), while 5(5/66, 7.6%)in the follow-up group(4.9% vs 7.6%, P=0.883). There was no significant difference in overall survival (OS) and disease-free survival (DFS) between the two study groups (P=0.066 and 0.938, respectively).
Conclusions:Assessment of LNM risk should be performed in patients with noncurative endoscopic resection. For patients with low risk of LNM who are intolerance of additional gastrectomy due to old age and comorbidities, close follow-up with endoscopy can be considered as an alternative.
