内镜黏膜下剥离术与内镜下黏膜切除术治疗早期胃癌的效果及术后出血的影响因素分析#br#

目的比较内镜黏膜下剥离术（ESD）与内镜下黏膜切除术（EMR）治疗早期胃癌的效果,分析两种手术后出血的影响因素。方法选取2017年8月至2019年5月首都医科大学附属北京天坛医院收治的92例早期胃癌患者,按治疗方法的不同将其分为ESD组（52例）与EMR组（40例）,比较两组治疗效果及术中、术后并发症发生情况;按术后出血情况,将本组92例患者分为出血组（8例）与未出血组（84例）,比较两组的临床资料,采用多因素Logistic回归分析术后出血的危险因素。结果两组患者均顺利完成手术。ESD组的完整切除率高于EMR组（904% vs. 700%）,治愈性切除率高于EMR组（769% vs. 550%）,差异有统计学意义（P<005）。ESD组的手术时长及切除病灶直径大于EMR组,差异有统计学意义（P<005）;ESD组的术后出血发生率与EMR组比较差异无统计学意义（96% vs. 75%,P>005）,术中穿孔发生率两组比较差异无统计学意义（P>005）;与未出血组比较,出血组患者长期使用抗凝药史比例高,病灶直径大,手术时间长,病灶位置为胃上1/3的比例高（P<005）。多因素Logistic分析结果显示,长期使用抗凝药物、病灶直径大、病灶位置为胃上1/3及手术时间长是影响早期胃癌患者术后出血的危险因素（P<005）。结论ESD治疗早期胃癌的病灶切除率高于EMR,长期使用抗凝药物、手术时间过长、胃上1/3部位病变及病变直径大于4 cm是早期胃癌患者行ESD或EMR术后出血的危险因素。     

内镜下套扎器联合圈套器在胃底黏膜下微小肿瘤治疗中的应用效果#br#

目的探讨内镜下套扎器联合圈套器在胃底黏膜下微小肿瘤治疗中的应用效果。方法 选取2016年3月至2020年12月于梅州市人民医院检查并择期行手术治疗的93例胃底黏膜下微小肿瘤患者，按手术方式的不同分为观察组（36例）与对照组（57例）。观察组采用套扎器联合圈套器辅助的内镜下黏膜切除术治疗，对照组采用常规内镜下黏膜剥离术治疗，术后均给予质子泵抑制剂（PPI）、抗生素、抑酸等常规治疗，并于术后3个月复查胃镜。记录两组患者的手术时间、术中出血量及术中穿孔情况，比较两组肿瘤完整切除率、切缘阳性率及术后并发症发生率，评估两组术后创面愈合情况。结果观察组手术时间较对照组更短[（3068±574）min vs. （4279±731）min]，术中出血量较对照组更少[（211±054）ml vs. （365±067）ml]，差异有统计学意义（P＜005），两组术中穿孔率、肿瘤完整切除率、切缘阳性率差异均无统计学意义（P＞005）。术后3个月复查胃镜，观察组创面愈合良好，见白色瘢痕，对照组溃疡1例，钛夹残留2例，其余患者创面瘢痕愈合良好，随访期间两组均无复发。观察组术后并发症发生率较对照组降低（1667% vs. 3684%，P＜005）。结论内镜下套扎器联合圈套器应用于胃底黏膜下微小肿瘤的治疗简化了手术程序，缩短了手术时间和患者住院时间，肿瘤完全切除率高，安全性佳。     

胃黏液腺癌与印戒细胞癌临床病理特征的对比研究

目的：分析比较胃黏液腺癌（mucinous gastric carcinoma,MGC）和印戒细胞癌（signet －ring cell carci-noma,SRC）的临床病理特征。方法：回顾性分析2002年－2014年我院及瑞金医院收治的59例 MGC 和75例SRC 患者的临床病理资料。结果：MGC 和 SRC 两组在发病年龄、肿瘤位置、肿瘤大体分型、浸润深度、临床TNM分期方面存在统计学差异（P ＜0．05）。在性别比例、肿瘤切除部位、淋巴结转移数目及分期、淋巴管浸润、静脉浸润、神经浸润、远处转移方面无统计学差异（P ＞0．05）。MGC 组病例淋巴结转移率为67．8％,SRC组淋巴结转移率为54．7％（P ＞0．05）。MGC 较 SRC 更易出现远处转移,但无统计学差异（P ＞0．05）。结论：MGC 与 SRC 相比,发病年龄更大、肿瘤体积更大、胃上部多见、隆起型多见、进展期多见、远处转移多见。两者淋巴结转移率都很高,但无统计学差异,故临床发现 MGC 或 SRC 时,要更加注意有无淋巴结及远处转移,尤其是 MGC。     

胃癌患者血清微小RNA 30水平及其临床意义#br# #br#

目的探讨胃癌患者的血清微小RNA 30（miR 30）水平并分析其与临床病理特征和预后的关系。 方法收集本院2014年3月至2017年5月108例胃癌患者的术前血清及同期100例健康体检者的血清样本,采用实时定量PCR（QPCR）检测以上样本的miR 30水平,比较胃癌患者与健康体检者的miR 30水平差异,以miR 30水平的均值为界值分为低表达组（＜均值）和高表达组（≥均值）,分析miR 30水平与临床病理参数（性别、年龄、淋巴结转移、肿瘤大小、TNM分期、浸润深度、Lauren分型和分化程度）的关系,根据随访数据比较不同血清miR 30水平的预后情况。 结果胃癌患者的血清miR 30水平为0624±0075,低于对照组的1028±0094,差异有统计学意义（P＜005）。ROC曲线分析结果显示miR 30诊断胃癌的曲线下面积为0802（95％CI：0742～0861,P＜0001）,诊断阈值取0798时,敏感度和特异度分别为759％和760％。胃癌患者的血清miR 30水平与性别、年龄、浸润深度和Lauren分型均无关（P＞005）,而与淋巴结转移、肿瘤大小、TNM分期和分化程度有关（P＜005）,其中淋巴结转移、肿瘤大小≥5 cm、TNM Ⅲ～Ⅳ期和低分化者的低表达率分别为632％（48／76）、726％（45／62）、923％（36／39）和681％（32／47）,均高于淋巴结无转移、肿瘤大小＜5 cm、TNM Ⅰ～Ⅱ期和中高分化者的375％（12／32）、326％（15／46）、348％（24／69）和459％（28／61）,差异有统计学意义（P＜005）。miR 30低表达组的中位总生存期为230个月,短于高表达组的360个月,差异有统计学意义（P＜005）。 结论miR 30在胃癌患者血清中低表达,参与胃癌的发生发展且低水平者的预后较差,具有作为胃癌筛查和预后预测标志物的潜能。     

不同年龄节点对甲状腺癌患者风险分层的#br# 评估效果#br#

目的评估第8版美国癌症联合委员会（AJCC）/TNM甲状腺癌分期系统中将甲状腺乳头状癌（PTC）风险分层的年龄节点从45岁增加到55岁后对PTC患者风险分层的价值。方法选取2016年6月至2020年12月南京医科大学附属逸夫医院收治的127例PTC患者。根据PTC诊断时的年龄将患者按照两个年龄节点（45岁和55岁）分为两组：<45岁组53例,≥45岁组74例;<55岁组91例,≥55岁组36例。比较各组患者的临床病理特征和术前超声特征的差异。使用单因素Logistic回归分析探讨年龄与肿瘤分期及淋巴结转移的关联性。结果≥55岁组与<55岁组pTNM分期、肿瘤分期及淋巴结转移差异有统计学意义（P<0001）。≥45岁组与<45岁组的pTNM分期差异有统计学意义（P<005）,肿瘤分期及淋巴结转移差异无统计学意义（P>005）。单因素Logistic回归分析结果显示,≥45岁组中局部晚期肿瘤（pT3+pT4）和淋巴结转移（pN1）的风险程度与<45岁组差异无统计学意义（P>005）。≥55岁组中局部晚期肿瘤和淋巴结转移的风险明显高于<55岁组（P<005）。同时根据术前彩超的特征,年长组（≥45岁和≥55岁）患者中存在肿块形状不规则、边界不清楚、微钙化、高血供及TI RADS高等级的比例均高于年轻组（<45岁和<55岁）,差异有统计学意义（P<005）。≥55岁组的肿块纵横比≥1和肿瘤直径<2 cm的比例高于<55岁组,差异有统计学意义（P<005）;但这两项特征在≥45岁组与<45岁组间差异无统计学意义（P>005）。结论以55岁作为PTC患者风险分层的年龄节点,可以更好地对不同预后的患者进行分层,在临床分期中更有价值。     

宫颈癌组织中微小RNA 155水平及其对细胞增殖和侵袭的影响#br# #br#

目的探讨微小RNA 155（miR 155）在宫颈癌组织中的表达及其对宫颈癌细胞增殖和侵袭的影响。 方法收集本院2014年5月至2016年12月经手术切除的宫颈癌组织76例、正常宫颈组织63例及宫颈上皮内瘤样病变（CIN）组织84例（CINⅠ级22例、CIN Ⅱ级29例和CIN Ⅲ级33例）,采用实时定量PCR（QPCR）检测以上组织中的miR 155水平,分析miR 155水平与宫颈癌临床病理特征（年龄、FIGO分期、肿瘤大小、组织学分级、病理类型、血管侵犯和淋巴结转移）的关系;向宫颈癌HeLa细胞分别转染miR 155抑制物（转染组）和阴性对照（对照组）,采用QPCR检测转染48 h后各组的miR 155水平,分别采用MTT法和Transwell侵袭实验检测增殖率和穿膜细胞数目。 结果QPCR检测发现宫颈癌组织中的miR 155水平为4270±1901,高于正常宫颈组织和CIN组织（P＜005）;miR 155水平与宫颈癌患者的年龄、组织学分级和病理类型均无关（P＞005）,但与FIGO分期、肿瘤大小、血管侵犯和淋巴结转移有关（P＜005）。转染miR 155抑制物48 h后,转染组HeLa细胞的miR 155水平为0265±0034,低于对照组的1027±0158,差异有统计学意义（P＜005）;与对照组相比,转染组的增殖率和穿膜细胞数均降低,差异有统计学意义（P＜005）。 结论miR 155在宫颈癌组织中呈高表达,且与临床分期、血管侵犯和淋巴结转移有关,参与宫颈癌的发生发展。降低miR 155水平可抑制增殖和侵袭过程,在宫颈癌的防治中有一定价值。     

ACAT1、BDH2基因与肾透明细胞癌患者发病及病情进展的关系#br#

目的研究胆固醇酰基转移酶1（ACAT1）、3 羟基丁酸脱氢酶2（BDH2）基因与肾透明细胞癌患者发病及病情进展的关系。方法选择2018年5月至2020年5月巴中市人民医院收治的86例肾透明细胞癌患者为研究组,另选择同期收治的因肾外伤行肾切除的患者30例为对照组,收集研究组术中切除的癌组织及对照组术中切除的肾组织,比较两组组织中ACAT1、BDH2基因相对表达量,比较不同临床病理特征肾透明细胞癌患者癌组织中ACAT1、BDH2基因相对表达量,采用Spearman相关分析ACAT1、BDH2基因与肾透明细胞癌患者病情进展的相关性,采用Logistic回归分析肾透明细胞癌患者发病的影响因素。结果研究组的ACAT1、BDH2基因相对表达量为1152±099、1048±073,均低于对照组（分别为1393±132、1286±101）,差异有统计学意义（P<005）;不同性别、年龄、肿瘤直径、肿瘤部位、病理分级的肾透明细胞癌患者癌组织中ACAT1、BDH2基因相对表达量差异无统计学意义（P>005）;不同病理分期、淋巴结转移情况的肾透明细胞癌患者癌组织中ACAT1、BDH2基因相对表达量差异有统计学意义（P<005）;ACAT1、BDH2基因相对表达量与肾透明细胞癌患者的病理分期、淋巴结转移呈负相关（P<005）;ACAT1、BDH2基因表达下调是肾透明细胞癌患者发病的危险因素（P<005）。结论ACAT1、BDH2基因在肾透明细胞癌中表达下调,ACAT1、BDH2基因与肾透明细胞癌发病及病理分期、淋巴结转移有关。     

内镜黏膜下剥离术治疗不同浸润深度早期胃癌的安全性及相关因素分析

目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)治疗不同浸润深度早期胃癌的临床安全性及其相关影响因素。方法:收集2012年01月01日至2018年12月31日在我院行ESD术的早期胃癌患者的临床相关资料,根据ESD术后病理,比较黏膜内癌组(M)与浅层黏膜下癌组(浸润深度≤500μm, SM1)患者的临床特征及临床预后,运用Logistic回归模型分析影响ESD术治愈性切除的相关因素。结果:276例患者中,M组247例,SM1组29例。M组与SM1组在病变大小、病变部位、术后病理类型方面差异有统计学意义(P<0.05);M组治愈性切除率远高于SM1组(94.74%vs 65.52%,χ²=29.007,P<0.05);M组与SM1组3年生存率(96.21%vs 86.67%),差异无统计学意义(χ²=0.540,P=0.463),术后并发症的发生差异也无统计学意义(P=0.572);有溃疡和浸润深度SM1是影响ESD术治愈性切除的相关因素。结论:ESD治疗不同浸润深度早期胃癌,...     

伴神经内分泌分化胃癌的临床病理特征及预后分析#br# #br#

目的比较伴与不伴神经内分泌分化（NED）胃癌患者的临床病理特征及预后。 方法回顾性分析2010年1月至2017年8月就诊于南京鼓楼医院伴NED 98例胃癌患者和同期不伴NED 338例患者的临床病理资料,比较两组患者临床病理特征的差异,Kaplan Meier法进行生存分析并行Log rank检验,Cox风险比例回归模型分析影响预后的独立影响因素。 结果伴与不伴NED的两组胃癌患者均具有以下特征：起病症状相似,年龄＜65岁和肿瘤直径≥4 cm更多见,神经浸润比例较高及淋巴结和远处转移比例相仿;而两组在性别、组织学类型、T分期、TNM分期及脉管浸润等方面的差异有统计学意义（P＜005）。CgA、Syn的阳性率分别为704％、755％,共同阳性率为459％。生存分析显示伴NED胃癌患者术后1、3、5年生存率分别为735％、462％、342％,明显低于不伴NED胃癌患者的889％、641％、537％,差异有统计学意义（P＜005）。单因素预后分析结果显示,伴NED胃癌患者的预后与年龄、肿瘤直径、分化程度、TNM分期、脉管和神经是否浸润有关（P＜005）。多因素分析结果显示,年龄是影响伴NED胃癌患者预后的独立因素（P＜005）。 结论免疫组化染色是判定胃癌伴NED的主要方法,伴NED胃癌患者预后较差。     

腹腔镜下三角吻合联合经自然腔道取标本用于近端胃癌根治术的效果分析#br#

目的探讨全腹腔镜下三角吻合联合经自然腔道取标本（NOSES）用于近端胃癌根治术的效果。方法选取安徽医科大学第二附属医院2019年10月至2020年10月收治的62例近端胃癌患者,按照治疗方法的不同分为研究组与对照组,各31例。研究组行近端胃部分切除腹腔镜下三角吻合消化道重建联合NOSES治疗,对照组行食管残胃吻合术联合经腹部切口取标本治疗。比较两组的手术效果、手术前后炎症反应及免疫功能指标,以及并发症发生情况。结果两组患者的性别、年龄、体质指数（BMI）、美国东部肿瘤协作组（ECOG）评分、肿瘤直径、美国麻醉医师协会（ASA）分级及病理分期比较差异无统计学意义（P>005）。研究组的手术时间、吻合时间、淋巴结清扫数大于对照组,术中出血量、术后首次排气时间、流质饮食时间、术后下床时间小于对照组,差异有统计学意义（P<005）,两组术后住院时间比较差异无统计学意义（P>005）。两组手术前后炎症反应指标[白细胞计数（WBC）、C反应蛋白（CRP）]及免疫功能指标[CD3+、CD4+、CD8+、CD4+/CD8+]比较差异无统计学意义（P>005）。两组术后并发症发生率比较差异无统计学意义（194% vs. 258%,P>005）。随访6个月,两组均无肿瘤复发、转移及死亡患者。结论近端胃癌患者采用全腹腔镜下三角吻合消化道重建联合NOSES治疗比食管残胃吻合术联合经腹部切口取标本治疗的效果更优,术后恢复更快,安全可靠。     

黏膜内早期胃癌青年患者临床病理特征及内镜下治疗适应证的探讨

  目的  探讨青年患者黏膜内早期胃癌临床病理特征、淋巴结转移风险及内镜黏膜下剥离术（endoscopic submucosal dissec? tion，ESD）适应证。  方法  回顾性选取2009年3月至2016年12月在安徽省立医院行胃癌根治术、临床病理资料完整的325例早期胃癌患者，所有患者均经术后病理证实为黏膜内癌。根据年龄（≤40岁和>40岁）分为青年组和中老年组，总结青年组临床病理特征和ESD治疗安全性。  结果  在所有黏膜内早期胃癌患者中，青年组患者30例（9.2%）。与中老年组相比，青年组黏膜内癌多发生于女性，病理类型以未分化型和混合型为主，更容易发生淋巴结转移。符合ESD适应证的分化型黏膜内癌的患者中，青年组淋巴结转移率为0；符合ESD相对适应证的未分化型黏膜内癌的患者中，青年组淋巴结转移率高达25.0%。  结论  青年患者黏膜内早期胃癌病理分化程度差，侵袭性更强，分化型黏膜内癌可考虑ESD治疗。      

A case of small undifferentiated intramucosal gastric cancer with lymph node metastasis

Early gastric cancer (EGC) has a favorable prognosis after surgical gastrectomy. For intramucosal EGC with little risk of lymph node metastasis, endoscopic mucosal resection (EMR) is an accepted treatment method. Herein we document a noteworthy case of small undifferentiated gastric cancer with nodal metastasis. A 60-year-old Japanese woman underwent gastrectomy with D2 lymph node dissection for the treatment of EGC in the lower gastric body. Histological examination revealed that signet-ring cell carcinoma was located in approximately one-third of the superficial portion of the mucosal layer, with a tumor size of 13 mm. No lymphatic invasion, venous invasion, or fibrosis was observed in the submucosal layer. This case had nodal metastasis and was finally diagnosed as stage IB (T1N1M0) according to the Japanese Classification of Gastric Carcinoma (JCGC). The patient is alive without recurrence 6 years after treatment.     

Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type,depth of wall invasion,and lymph node metastasis

Background Limited surgery by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for gastric cancer is frequently performed in many institutions. These techniques do preserve gastric function and maintain a high quality of life but may compromise survival. The treatment strategy for early tumors should therefore be based on a complete cure, and limited surgery must thus have clear indications. Methods D2 gastric resection was performed in 278 early gastric adenocarcinomas, and a retrospective histological review of the specimens was made. The extended indications for EMR or ESD, according to the Japanese Gastric Cancer Association Treatment guidelines for gastric cancer in Japan, were also assessed. Results Of the 278 early gastric cancers, 115 were mucosal (M) cancers without ulcer. No lymph node metastases were seen in these specimens. Six of the 41 specimens of M cancer with ulcers had lymph node metastases at the N1 level only. One of these had lymph node metastases from a tumor measuring less than 3 cm in size. Twenty-eight of 122 submucosal cancers had lymph node metastases (23%). Twenty of these were SM1 tumors and 5 had lymph node metastases; 4 of these 5 had lymph node metastases despite the absence of vascular invasion. Conclusion Three cases had lymph node metastases that met the extended criteria for EMR/ESD. EMR and/or ESD should be limited to M cancers without ulcer or differentiated-type M cancer with ulcers smaller than 2 cm. When the depth of tumor invasion is deeper than M, then a gastric resection with lymph node dissection is necessary.     

早期胃癌的淋巴结转移规律及预后分析

目的 分析早期胃癌的临床病理特征与预后之间的关系及早期胃癌的淋巴结转移规律.方法 对1994年1月～2005年10月手术治疗并有完整资料的255例早期胃癌的临床病理学资料进行回顾性分析.结果 255例患者的总5年生存率为91.4%.单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄...     

Efficacy and safety of grasping forceps-assisted endoscopic resection for gastric neoplasms: A multi-centre retrospective study

BACKGROUNDEndoscopic submucosal dissection (ESD) is widely accepted for early gastric cancer (EGC) without lymph node metastasis, although ESD is challenging, even for small lesions, in the greater curvature (GC) of the upper (U) and middle (M) thirds of the stomach. Grasping forceps-assisted endoscopic resection (GF-ER) is a type of endoscopic mucosal resection that is performed via a double-channel endoscope. AIMTo investigate the safety and efficacy of GF-ER vs ESD in the GC of the stomach’s U and M regions.METHODSWe retrospectively reviewed the medical records of 506 patients who underwent ER of 522 EGC lesions in the stomach’s U and M regions in three institutions between January 2016 and May 2020. Nine lesions from eight patients who underwent GF-ER for EGC (the GF-ER group) were compared to 63 lesions from 63 patients who underwent ESD (the ESD group). We also performed a subgroup analysis of small lesions (≤ 10 mm) in 6 patients (7 lesions) from the GF-ER group and 20 patients (20 lesions) from the ESD group. RESULTSThere were no statistically significant differences between the GF-ER and ESD groups in the en bloc resection rates (100% vs 100%) and the R0 resection rates (100% vs 98.4%). The median procedure time in the GF-ER group was shorter than that in the ESD group (4.0 min vs 55.0 min, P < 0.01). There were no adverse events in the GF-ER group, although five perforations (8.0%) and 1 case of postoperative bleeding (1.6%) were observed in the ESD group. When we only considered lesions that were ≤ 10 mm, the median procedure time in the GF-ER group was still shorter than that in the ESD group (4.0 min vs 35.0 min, P < 0.01). There were no adverse events in the GF-ER group, although 1 case of perforation (1.6%) were observed in the ESD group.CONCLUSIONThese findings suggest that GF-ER may be an effective therapeutic option for small lesions in the GC of the stomach’s U and M regions.     

未分化型早期胃癌的淋巴结转移规律分析

目的探讨未分化型早期胃癌(EGC)的淋巴结转移规律。方法对1994年1月至2008年12月手术治疗的335例早期胃癌的临床病理学资料进行回顾性分析。结果未分化型早期胃癌的淋巴结转移率为17.9%,其中黏膜内癌(M癌)和黏膜下层癌(SM癌)的淋巴结转移率分别为10.5%、25.6%,直径≤2.0cm和>2.0cm的淋巴结转移率分别为8.0%和25.8%,脉管瘤栓阳性和脉管瘤栓阴性的淋巴结转移率为50.0%和16.3%。单因素分析显示,肿瘤大小、浸润深度、脉管瘤栓与未分化型早期胃癌淋巴结转移相关(P<0.05)。多因素分析显示,肿瘤最大径>2cm、黏膜下层浸润和脉管瘤栓是未分化型早期胃癌淋巴结转移的独立危险因素(P<0.05)。结论肿瘤直径≤2cm、黏膜内癌、无脉管瘤栓的未分化型早期胃癌发生淋巴结转移风险小。     

Two rare cases of node-positive differentiated gastric cancer despite their infiltration to sm1, their small size, and lack of lymphatic invasion into the submucosal layer

Early gastric cancer without lymph node metastasis has been reported after the analysis of many cases, and a consensus has been reached about this condition. We report two cases of node-positive differentiated sm1 gastric cancer without lymphatic invasion into the submucosal layer. Case 1 was a 73-year-old man who underwent EMR for 0-IIc early gastric cancer (EGC) on the gastric angle, with a histological diagnosis of tub1. Pathological examination revealed a 0-IIc lesion that was 12 mm in size and sm1 in invasion depth without lymphatic-vascular invasion. However, the infiltration in the submucosal layer was relatively wide. The patient subsequently underwent distal gastrectomy with D2 lymph node dissection. Pathological examination revealed level 2 lymph node metastasis. Case 2 was a 62-year-old woman who underwent ER for a 0-I+IIc-type EGC on the greater curvature of the antrum, with a histological diagnosis of tub1. Pathological examination revealed a 0-I+IIc-type lesion that was 15 mm in size and sm1 in depth. Lymphatic invasions in the muscularis mucosa were found, but none were seen in the submucosal layer. Two years later, follow-up computed tomography (CT) showed a lymph node swelling in the infrapyloric region. Distal gastrectomy with D2 dissection was then performed, and pathological examination revealed level 1 lymph node metastasis. Although the lesions in both patients satisfied the criteria of Gotoda et al. for minimal risk of nodal involvement, lymph node metastasis was observed in these patients. Curative surgery with lymph node dissection is thus required in patients with wide infiltration of the submucosal layer or lymphatic invasion in the muscularis mucosa.     

Endoscopic resection of early gastric cancer

The purpose of this review is to examine recent advances in the techniques and technologies of endoscopic resection of early gastric cancer (EGC). Endoscopic mucosal resection (EMR) of EGC, with negligible risk of lymph node metastasis, is a standard technique in Japan and is increasingly becoming accepted and regularly used in Western countries. EMR is a minimally invasive technique which is safe, convenient, and efficacious; however, it is insufficient when treating larger lesions. The evidence suggests that difficulties with the correct assessment of depth of tumor invasion lead to an increase in local recurrence with standard EMR when lesions are larger than 15 mm. A major factor contributing to this increase in local recurrence relates to lesions being excised piecemeal due to the technical limitations of standard EMR. A new development in endoscopic techniques is to dissect directly along the submucosal layer — a procedure called endoscopic submucosal dissection (ESD). This allows the en-bloc resection of larger lesions. ESD is not necessarily limited by lesion size and it is predicted to replace conventional surgery in dealing with certain stages of ECG. However, it still has a higher complication rate when compared to standard EMR, and it requires high levels of endoscopic skill and experience. Endoscopic techniques, indications, pathological assessment, and methods of endoscopic resection of EGC need to be established for carrying out appropriate treatment and for the collation of long-term outcome data.     

Successful application of laparoscopic and endoscopic cooperative surgery (LECS) for a lateral-spreading mucosal gastric cancer

In the current era of endoscopic submucosal dissection (ESD) for early gastric cancer, which carries a negligible risk of lymph node metastasis, local resection of the stomach remains an option for these lesions. This is particularly so for a large intramucosal lesion or a lesion with a strong ulcer scar, for which ESD becomes a difficult option. Here, we describe a case of lateral-spreading intramucosal gastric cancer of 6-cm diameter located at the fornix of the stomach, which was successfully treated by laparoscopic and endoscopic cooperative surgery (LECS) because of the expected risk of complications during ESD. In the LECS procedure, the resection margin was appropriately determined by the endoscopic evaluation in detail and by the ESD technique. If early gastric cancer fits the criteria for endoscopic resection but would present difficulty if performing ESD, this is a good indication for the LECS procedure.     

Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC).

BACKGROUND: Lymph node metastases are present in only about 15% of patients with early gastric cancer (EGC) and for this reason, the majority of these patients do not require lymphadenectomy. In Japan, EGC patients undergo less invasive treatment (endoscopic mucosal resection, wedge resection, laparoscopy). However, the indications for and results of these types of treatment are still uncertain. METHODS: In a multicentre retrospective study, we analysed the clinicopathological data referring to 584 early gastric cancer patients who underwent D2 gastrectomy. A comparison was made between patients with and without lymph node metastases in relation to numerous pre- and postoperative variables. Long-term survival and risk factors for lymph node metastases were analysed. The primary aim was to compare our results with those of Western and Japanese authors; we also evaluated the possibility of identifying a subset of patients at low risk of lymph node metastases who may be candidates for endoscopic treatment. RESULTS: The incidence of lymph node metastasis was 14.4%. Univariate and multivariate analyses showed that submucosal infiltration, diffuse histotype, tumour size and Kodama Pen A type were all related to the presence of lymph node metastases. Patients with types I, IIa and IIb mucosal tumours did not present lymph node metastases. Postoperative mortality was 2.2%. Five-year survival in relation to lymph node groups was 95% in N0 patients, 77% in N1 patients and 60% in N2 patients (p = 0.0001, Japanese N-stage). The number of positive lymph nodes also had a prognostic value. Patients with three or fewer positive lymph nodes presented a better 5-year prognosis (83%) than those with more than three positive lymph nodes (48%) (p = 0.0001). CONCLUSIONS: Our study confirms that lymph node involvement is an extremely important prognostic factor. For this reason, the therapeutic strategy of our surgical units is as follows: 1) D2 gastrectomy is the standard treatment even in early gastric cancer (EGC); 2) endoscopic mucosal resection (EMR) could be considered first in types I, IIa and IIb tumours that are diagnosed as limited to the mucosal layer.