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A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer.

机译：早期胃癌内镜黏膜下剥离扩大适应证的可行性研究。

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BACKGROUND: Endoscopic submucosal dissection (ESD) is the standard treatment for selected cases of early gastric cancer (EGC). Evolution of ESD techniques and accessories has expanded treatment indications. The aim of this study was to compare the therapeutic outcomes for conventional and expanded indications of ESD for EGC. METHODS: Eight hundred six EGC lesions in 780 patients were classified into two groups based on a pathological review: a conventional indication group (595 cases) and an expanded indication group (211 cases). The expanded indication group was classified further into subgroups according to tumor depth and tumor size. Therapeutic outcomes were compared between the conventional and expanded indication groups and between the expanded indication subgroups. RESULTS: The complete resection rate (97.3% vs. 81.0%, p<0.001) and en bloc complete resection rate (95.6% vs. 79.1%, p=0.003) were higher in the conventional indication group than in the expanded indication group. Among the expanded indication patients, the complete resection rate (64.5% vs. 91.1%, p<0.001) and en bloc complete resection rate (63.2% vs. 89.6%, p<0.001) were lower in the submucosal invasion subgroup than in the mucosal invasion subgroup. The complete resection rate and en bloc complete resection rate did not differ between subgroups classified according to tumor size in the expanded indication group. The conventional indication group and expanded indication group did not differ with regard to the rates of local recurrence (0.7% vs. 0%), metachronous recurrence (3.6% vs. 3.3%), or cumulative disease-free survival. Survival outcome was similar in the subgroups classified by tumor depth and size. Perforation was more frequent in the expanded indication group than in the conventional indication group (6.6% vs. 2.4%, p<0.001). CONCLUSION: ESD for expanded indication of EGC had acceptable clinical outcomes. ESD can be applied safely to properly selected patients with EGC.
机译：背景：内镜黏膜下剥离术（ESD）是某些早期胃癌（EGC）病例的标准治疗方法。 ESD技术和附件的发展扩大了治疗适应症。这项研究的目的是比较EGC的ESD常规和扩展适应症的治疗结果。方法：根据病理学检查，将780例患者的886例EGC病变分为两组：常规适应症组（595例）和扩大适应症组（211例）。根据肿瘤深度和肿瘤大小，扩大适应症组进一步分为亚组。比较了常规适应症组和扩展适应症组以及扩展适应症亚组之间的治疗结果。结果：常规适应证组的完全切除率（97.3％vs. 81.0％，p <0.001）和整体完全切除率（95.6％vs. 79.1％，p = 0.003）高于扩大适应证组。在扩大适应症患者中，粘膜下浸润亚组的完全切除率（64.5％vs. 91.1％，p <0.001）和整体完全切除率（63.2％vs. 89.6％，p <0.001）低于黏膜下浸润亚组。粘膜浸润亚组。在扩大的适应症组中，根据肿瘤大小分类的亚组之间的完全切除率和整体完全切除率没有差异。常规适应证组和扩大适应证组在局部复发率（0.7％vs. 0％），异时复发率（3.6％vs. 3.3％）或累积无病生存率方面没有差异。在按肿瘤深度和大小分类的亚组中，生存结果相似。与常规适应症组相比，扩大适应症组的穿孔频率更高（6.6％vs. 2.4％，p <0.001）。结论：ESD用于扩大EGC适应症具有可接受的临床效果。 ESD可以安全地应用于正确选择的EGC患者。

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