Stomach and Intestine(Tokyo) Volume 43, Issue 1 (January 2008)

Current Status of Endoscopic Submucosal Dissection(ESD) in Early Stomach Cancer ― The Results of Excising the Lesions Eligible Under the Extended Indications and an Analysis of the Factors Leading to Non-en bloc Complete Resection Takashi Nagahama 1 , Suketo Sou 2 , Makoto Yorioka 3 , Rieko Fukami 3 , Keiichi Furukawa 4 , Hiroyuki Uno 4 , Yuki Koga 5 , Ikuhito Hirai 1 , Kenshi Yao 1 , Yasuhiro Takaki 1 , Shinichiro Maki 1 , Takashi Hisabe 1 , Sumio Tsuda 1 , Toshiyuki Matsui 1 , Hiroshi Tanabe 6 , Nobuhiro Nishimata 6 , Seiji Haraoka 6 , Akinori Iwashita 6 1Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan 2Department of Internal Medicine, Tobata Kyoritsu Hospital, Kitakyushu, Japan 3Department of Gastroenterology, Sada Hospital, Fukuoka, Japan 4Department of Gastroenterology, Fukuoka City Medical Association Hospital, Fukuoka, Japan 5Department of Gastroenterology, Shin Kokura Hospital, Kitakyushu, Japan 6Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan Keyword: 早期胃癌 , ESD , 適応拡大病変 , 根治度 , 一括完全切除 pp.61-73
Published Date 2008/1/25
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 The study was conducted on lesions in 583 patients with early stomach cancer who underwent ESD at our hospital or affiliated institutions. The study consisted of the following two parts:(1)The rate of complete resection(CR)of the guideline lesions(cGL)presumed according to pre-operative diagnosis and the lesions eligible under the extended indications(cEXT), as well as non-CR factors of these groups, were compared;and(2)The lesions compared were classified according to an adaptive standard based on the histopathological diagnosis and the rate of en bloc complete resection(ECR). In addition, factors for non-ECR were analyzed. (1)The rate for CR was 78.9% for cEXT and 89.2% for cGL, with the former being significantly lower(p=0.0007). When the two groups were compared for the factors that led to the judgment of non-CR, no difference was found between the clinical diagnosis or in the resectional technology;but a pathological factor(vascular invasion, ≧31 mm, SM1) was found more frequently in cEXT(p=0.01). (2)The rate of ECR was 94.1% for pGL and 91.3% for pEXT, with no difference between the two. However, it was 72.9% for the lesions excluded from the indications(pEXC), which was significantly lower than the other two(p=0.0003 and p=0.0004). The frequency of perforation for pEXC was significantly higher than the other two(p=0.09). A multivariate analysis was conducted for the factor involving non-ECR(55 lesions). The depth of tumor invasion was SM2 with the development of intra-operative complications. A tumor diameter of ≧31 mm is a significant risk factor, while the L region for the site of development and a duration of ESD of<3 hours were significant non-risk factors. These findings indicated that the current standard for adaptive extension is appropriate in the light of excisional technology but for further improvement in the rate of radical cure, amelioration of the ECR rate for those lesions measuring more than 31 mm in tumor diameter and measures to counteract intra-operative complications are necessary.

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43巻1号 (2008年1月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院