内镜黏膜下剥离术治疗早期胃癌的可行性研究

目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌的可行性。方法选取142例早期胃癌患者作为研究对象,观察ESD与EMR(内镜黏膜切除术)治疗早期胃癌的临床疗效。结果 ESD组一次性完全切除率、治愈性切除率均显著高于EMR组(P<0.05);ESD组可能治愈性切除率、非治愈性切除率显著低于EMR组(P<0.05);ESD组肿瘤复发率显著低于EMR组(P<0.05);ESD组术中出血率和穿孔率分别为3.53%和2.35%,均显著低于EMR组的19.30%和8.77%(P<0.05);ESD组3年生存率显著高于EMR组(P<0.05)。结论 ESD治疗早期胃癌具有病灶切除彻底、复发率低、并发症少等优点,具有较好的应用前景。     

胃上部与胃中下部早期癌的临床病理特征#br# 比较研究#br#

目的对比分析胃上部早期癌（UGC）与胃中下部早期癌（M LGC）的临床及病理特征。方法回顾性分析2016年1月至2020年5月于南京医科大学第一附属医院消化内科接受内镜黏膜下剥离术（ESD）且术后病理证实为早期胃癌（EGC）的379例患者的临床病理资料,根据患者病灶部位分为UGC组（180例）与M LGC组（199例）,比较两组患者的基本资料、病灶内镜下特征及随访情况等。采用Logistic回归分析EGC黏膜下浸润及淋巴结转移的危险因素。结果UGC组年龄≥60岁、男性比例高于M LGC组,慢性萎缩性胃炎、肠上皮化生比例低于M LGC组,差异有统计学意义（P<005）。两组巴黎分型、组织学类型、黏膜下浸润、淋巴结转移差异有统计学意义（P<005）,肿瘤直径和治愈性切除差异无统计学意义（P>005）。UGC组、M LGC组发生黏膜下浸润者分别有66例、34例。Logistic回归分析显示,胃上部位置、淋巴结转移、未分化型是EGC黏膜下浸润的独立危险因素。肿瘤黏膜下浸润、未分化型是EGC淋巴结转移的独立危险因素。两组短期疗效（整块切除、完全切除、愈性切除、出血、穿孔）和长期疗效（复发、死亡）差异均无统计学意义（P>005）。结论在评估UGC达到ESD适应证的前提下,可优先选择内镜下切除。     

早期胃癌的浸润深度与淋巴结转移关系

目的:探讨早期胃癌的浸润深度、肿瘤大小与淋巴结转移之间的相关性.方法:收集103例外科手术切除的早期胃癌,统计不同时期早期胃癌的检出率,分析其临床及病理特点.结果:103例早期胃癌中黏膜内癌(M)31例,仅有1例(3%)淋巴结转移,黏膜下癌(SM)有63例,淋巴结转移率为17%,其中SM1:16.1%,SM2:34%,SM3:35%;肿瘤最大直径超过2cm的淋巴结转移率(20%)较直径≤2cm者(8.8%)高;肉眼类型中Ⅱ型最多见,并淋巴结转移率也最高;组织类型中高分化腺癌最多,其次为低分化腺癌;且低分化腺癌淋巴结转移率高.结论:早期胃癌的淋巴结转移与肿瘤的浸润深度、肿瘤的大小、肉眼所见及组织类型有关.     

围手术期精细化护理在早期胃癌内镜下黏膜剥离术中的应用

目的 探讨围手术期精细化护理在早期胃癌内镜下黏膜剥离术(ESD)中的应用价值。方法 收集2018年1月至2020年6月在郑州大学第一附属医院接受ESD治疗的98例早期胃癌患者,根据护理方式不同分为2组,对照组采用常规护理模式,观察组采用围手术期精细化护理模式,比较分析2组患者的并发症发生率、护理满意度、住院费用和住院时间等指标。结果 观察组的并发症发生率、住院费用和住院时间分别为10.20%、(1.85±0.57)万元、(6.12±1.59)d,均低于对照组的57.14%、(2.31±0.87)万元、(7.34±2.96)d,差异均有统计学意义(χ²=24.169,P<0.001;t=3.096,P=0.003;t=2.542,P=0.012);护理满意度为97.96%,高于对照组的81.63%,差异有统计学意义(χ²=7.127,P=0.008)。结论 围手术期精细化护理在进行ESD治疗的早期胃癌患者中,可降低不良事件发生率和住院费用,缩短住院时间,并提高护理满意度,值得临床推广。     

早期食管癌患者内镜下黏膜剥离术后延迟性出血的危险因素分析

目的 探讨早期食管癌内镜下黏膜剥离术(ESD)后延迟性出血的高危因素。方法 回顾性分析早期食管癌患者216例的临床资料,所有入选者均顺利完成ESD治疗。术后对患者进行随访,根据患者是否发生延迟性出血分为发生组与未发生组。统计两组临床资料,分析早期食管癌患者ESD术后延迟性出血的危险因素。结果 216例早期食管癌患者经ESD治疗后,20例发生延迟性出血,发生率为9.26%(20/216);发生组年龄≥60岁、肿瘤直径≥3 cm、术中出血、浸润深度(M3)占比均高于未发生组,差异有统计学意义(P<0.05);两组性别、基础疾病、肿瘤位置、术中使用肾上腺素、病理分类、抗凝或抗血小板药物使用史等对比,差异无统计学意义(P>0.05);Logistic回归分析：年龄≥60岁、肿瘤直径≥3 cm、术中出血、浸润深度(M3)是早期食管癌患者ESD术后延迟性出血的独立危险因素(P<0.05且OR≥1)。结论 早期食管癌患者ESD术后易发生延迟性出血,年龄≥60岁、肿瘤直径≥3 cm、术中出血、浸润深度(M3)是其独立危险因素,临床需予以高度重视。     

早期胃癌的浸润深度与淋巴结转移关系

目的：探讨早期胃癌的浸润深度、肿瘤大小与淋巴结转移之间的相关性。方法：收集103例外科手术切除的早期胃癌,统计不同时期早期胃癌的检出率,分析其临床及病理特点。结果：103例早期胃癌中黏膜内癌（M）31例,仅有1例（3％）淋巴结转移,黏膜下癌（SM）有63例,淋巴结转移率为17％,其中SM1：16．1％,SM2：34％,SM3：35％;肿瘤最大直径超过2cn的淋巴结转移率（20％）较直径≤2cm者（8．8％）高;肉眼类型中Ⅱ型最多见,并淋巴结转移率也最高;组织类型中高分化腺癌最多,其次为低分化腺癌;且低分化腺癌淋巴结转移率高。结论：早期胃癌的淋巴结转移与肿瘤的浸润深度、肿瘤的大小、肉眼所见及组织类型有关。     

早期胃癌ESD治疗后腹腔镜补救手术3例并文献复习

目的 探讨早期胃癌患者行内镜黏膜下剥离术(ESD)后未达治愈标准的补救方式的选择及行腹腔镜补救手术的安全性和可行性.方法 收集3例早期胃癌ESD治疗后未达治愈标准再行腹腔镜补救手术患者的病例资料,分析其临床病理特征及补救手术指征,并对手术效果进行评价.结果 3例行腹腔镜补救根治性手术的早期胃癌患者ESD治疗均整块切除,术后病理示3例患者的病变黏膜下浸润均超过500μm,其中垂直切缘阳性患者1例,有静脉浸润患者1例,病变直径大于3 cm的患者2例;3例患者行腹腔镜补救手术均无中转开腹,术后均未发现有癌残留及淋巴结转移;手术时间111~151 min,术中出血量50~100 ml,无术中输血.术后排气时间为3~5 d,拔除胃管时间为4~6 d,拔除引流管时间为6~7 d,术后住院天数为8~13 d;3例患者均无手术相关并发症.结论 腹腔镜补救根治性手术是非治愈性ESD后一种安全有效的补救方式.     

早期胃癌缩小手术适应症选择的研究

目的探讨早期胃癌缩小手术的手术指征.方法对147例治愈性切除的早期胃癌的临床病理资料进行对比分析.结果 147例早期胃癌淋巴结转移率为11.6%(17/147).粘膜内癌(M癌)转移仅限于第一站淋巴结.粘膜下浸润癌(SM癌)第二站淋巴结转移度为62.5%(10/16),限于No7、8a淋巴结.Ⅱa型及Ⅱb型M癌未发现转移,而Ⅰ型,Ⅱc型Ⅲ型(主要是SM癌)有较高转移率.分化型癌的淋巴转移率为8.9%(9/101),低于未分化型17.4%(8/46).癌灶内不伴有溃疡的早期癌淋巴结转移率为6.9%,伴有溃疡者转移率明显增高为18.3%.结论 M癌是缩小手术的最好指征.SM癌大多不适合缩小手术,应将开腹标准根治术(D2)作为其基本术式;但对≤10mm的分化型SM癌可考虑开腹缩小手术(D1+a).     

内镜黏膜下剥离术治疗早期胃癌的临床疗效及患者发生脉管浸润的影响因素

目的 探讨内镜黏膜下剥离术（ESD）治疗早期胃癌的临床疗效及患者发生脉管浸润的影响因素。方法根据治疗方法的不同将127例早期胃癌患者分为对照组（n=62）和观察组（n=65）,对照组患者采用传统胃癌根治术治疗,观察组患者采用ESD治疗。比较两组患者的临床疗效、并发症发生率。比较不同临床特征早期胃癌患者的脉管浸润情况,采用Logistic回归模型分析早期胃癌患者发生脉管浸润的影响因素。结果 观察组患者的疾病控制率为98.46%,高于对照组患者的88.71%,差异有统计学意义（P﹤0.05）。观察组患者的并发症总发生率为3.08%,低于对照组患者的14.52%,差异有统计学意义（P﹤0.05）。以病理检查结果为金标准,127例早期胃癌患者中,脉管浸润32例,无脉管浸润95例。单因素分析结果显示,性别、年龄、肿瘤直径均可能与早期胃癌患者发生脉管浸润无关（P﹥0.05）;淋巴结转移情况、肿瘤分化程度、肿瘤浸润深度、肿瘤大体分型均可能与早期胃癌患者发生脉管浸润有关（P﹤0.05）。多因素Logistic回归分析结果显示,有淋巴结转移、肿瘤分化程度为低分化、肿瘤浸润深度为黏膜下层、肿瘤大体分型为溃...     

食管鳞癌组织中RECK和MMP-9基因mRNA检测与分析

目的 :探讨RECK和MMP-9在食管鳞状上皮细胞癌中的作用及其与临床病理因素的关系。 方法 :收集河南省安阳市肿瘤医院食管癌标本62例、癌旁不典型增生组织31例及正常食管粘膜组织62例。应用原位杂交方法检测每例食管标本RECK和MMP-9mRNA的表达情况。应用χ²检验,Speannan等级相关分析在SPSS13.0统计软件上作相关统计。 结果 :在食管鳞癌癌变过程中RECK在食管鳞癌组织、癌旁不典型增生组织及正常食管粘膜组织中mRNA的表达率依次增高,分别为45.2%(28/62)、61.3%(19/31)、82.3%(51/62),组间比较差异有统计学意义(χ²=19.186,P<0.05);不同分化程度、不同浸润深度及有无淋巴结转移的食管鳞癌组织之间RECKmRNA阳性表达率差异均有统计学意义(χ²分别为6.799、7.862、9.121,P均<0.05)。食管鳞癌组织及癌旁不典型增生组织中MMP-9mR-NA表达均高于正常食管粘膜组织,表达率分别为71.0%(44/62)、54.8%(17/31)、48.4%(30/62),组间比较差异有统计学意义(χ²=6.876,P<0.05);食管鳞癌组织中MMP-9mRNA表达与癌组织的分化程度、不同浸润深度及有无淋巴结转移密切相关(χ²分别为7.458,11.737,3.916,P均<0.05)。RECK和MMP-9mRNA表达率均与食管癌患者的性别、年龄无显著相关关系(P均>0.05)。RECK和MMP-9的mRNA的表达呈负相关关系(γ=-0.348,P<0.01)。 结论 :RECK mRNA表达率降低与MMP-9mRNA表达率升高可能与食管鳞癌的发生、发展及浸润转移有关。     

Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

Background

The 2010 Japanese Gastric Cancer Association guidelines for the treatment of submucosal invasive gastric cancer (SM-GC) specify size 30?mm or less, differentiated-dominant histology, lack of vessel involvement, and submucosal invasion of less than 500???m (SM1) as expanded criteria for curative endoscopic resection. Our purpose in this study was to confirm the validity of the expanded indications for curative endoscopic submucosal dissection (ESD) of SM-GC.

Methods

The study subjects were 173 patients with SM-GC resected by ESD at Hiroshima University Hospital between April 2002 and September 2010, including 99 patients for whom 3-plus years?? follow-up information was available. Post-ESD outcomes were compared between cases of SM1-GC that met the expanded ESD criteria, those that did not, and SM2-GC cases.

Results

Complete resection was achieved for 93.2% of the SM1-GCs that met the expanded criteria. There was neither metastasis to lymph nodes or other organs nor local recurrence among the SM1-GCs. Disease-specific survival did not differ significantly between patients that were simply followed up after ESD and those that were treated by additional surgical resection.

Conclusions

Our outcome data support the clinical validity of ESD without additional surgical resection for SM1-GCs that meet the expanded criteria.     

Prediction of invasion depth for submucosal differentiated gastric cancer by magnifying endoscopy with narrow-band imaging

The usefulness of determining gastric cancer invasion depth by magnifying endoscopy with narrow-band imaging (NBI-ME) has not been established. The objective of our study was to retrospectively compare NBI-ME images of differentiated submucosal (SM) 1 cancer with those of SM2 to identify the indicators of invasion depth for SM2 gastric cancer. Fifteen patients with SM1 differentiated gastric cancer and 20 with SM2 removed by endoscopic submucosal resection (ESD) were included. NBI-ME images matching the invasion depth of pathological specimens were examined to define the following three findings as diagnostic indicators of SM2: non-structure, scattery vessels and multi-caliber vessels. The relationship between indicators and invasion depth and between indicator score and invasion depth was examined in 27 patients (SM1/SM2: 11/16) with depressed-type gastric cancer (D-GC) and in 8 (SM1/SM2: 4/4) with protruding-type gastric cancer (P-GC). Diagnostic accuracy for invasion depth determined by four endoscopists using regular endoscopic images was compared with that determined by the same endoscopists using NBI-ME. In D-GC, all three indicators were significantly more frequent in SM2 than in SM1 (p<0.05). All D-GC with ≥2 points were SM2, demonstrating a significant difference in score distribution between SM1 and SM2 (p<0.05). In D-GC, diagnostic accuracy by NBI-ME was higher than that by regular endoscopy by all 4 endoscopists (p<0.05). NBI-ME findings of non-structure, scattery vessels and multi-caliber vessels can possibly serve as indicators of SM2 invasion in differentiated D-GC. Scoring of the three indicators was significant.     

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.     

内镜黏膜下剥离术治疗早期胃癌术后复发相关危险因素分析

目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌术后复发相关危险因素.方法:选取2012年01月至2018年06月在我院消化内科接受ESD治疗的206例早期胃癌患者的临床病历资料进行回顾性分析.根据术后复发情况将患者分为复发组和无复发组.比较两组患者临床...     

内镜黏膜下剥离术治疗早期胃癌的效果研究

目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌的安全性和有效性。方法根据手术方式不同将98例早期胃癌患者分为对照组与观察组,每组49例。对照组采用外科手术治疗,观察组采用ESD治疗,比较两组患者手术一般情况、肿瘤整块切除率和治愈性切除率以及术后并发症发生情况。观察两组术前、术后7天血浆中肠道功能指标(D-乳酸、二胺氧化酶)水平变化和1年内复发情况。结果观察组患者手术时间和术后住院时间均明显短于对照组,两组比较差异均有统计学意义(P﹤0.01)。两组患者肿瘤整块切除率、治愈性切除率比较,差异均无统计学意义(P﹥0.05)。两组患者1年内复发率比较,差异无统计学意义(P﹥0.05)。两组并发症总发生率比较,差异有统计学意义(P﹤0.05)。术前,两组患者D-乳酸、二胺氧化酶水平比较,差异均无统计学意义(P﹥0.05);术后7天,观察组D-乳酸、二胺氧化酶水平均低于对照组(P﹤0.05)。结论ESD治疗早期胃癌效果较好,安全性较高,能够减少患者手术时间、住院时间以及并发症的发生,促进患者康复。     

A case of lymph node metastasis following a curative endoscopic submucosal dissection of an early gastric cancer

Currently in Japan, differentiated gastric submucosal invasive cancers <500 μm (SM1) with negative lymphovascular involvement are included in expanded pathological criteria for curative endoscopic treatment. This is based on a retrospective examination of surgical resection cases in which patients suitable for such expanded criteria were determined to have a negligible risk of lymph node metastasis. We performed endoscopic submucosal dissection on a 65-year-old male with early gastric cancer in April 2005, and pathology revealed a well-differentiated adenocarcinoma, 21 × 10 mm in size, SM1 invasion depth and negative lymphovascular invasion as well as tumor-free margins, so the case was diagnosed as a curative resection. This case, however, resulted in lymph node metastasis that was diagnosed by endoscopic ultrasonography with fine-needle aspiration biopsy in May 2009. Distal gastrectomy with D2 lymph node dissection was then performed, confirming lymph node metastasis from the original gastric cancer.     

Efficacy of Endoscopic Submucosal Dissection for Cancer of the Operated Stomach

Purpose

Cancer can develop in the operated stomach after partial gastrectomy and in the reconstructed gastric tube after surgery for esophageal cancer. It is considered that endoscopic therapy is more safe and suitable for the early gastric cancer developed in such stomach than operation. We investigated the efficacy of endoscopic submucosal dissection (ESD) for cancer of the operated stomach.

Methods

Subjects were 669 gastric cancer patients who underwent ESD: 22 patients (23 lesions) had surgically altered gastric anatomy, whereas 647 patients (727 lesions) had normal gastric anatomy. In the altered gastric anatomy group, 13 patients, 6 patients, and 3 patients had previously undergone distal gastrectomy, gastric tube reconstruction, and proximal gastrectomy, respectively. Rates of complete en bloc resection and curative resection were compared between the two groups. Influence of an anastomotic site and/or a suture line on ESD outcomes was examined in the altered gastric anatomy group.

Results

The rate of complete en bloc resection by ESD was 82.6 % (19/23 lesions) in the altered gastric anatomy group and 92.3 % (671/727 lesions) in the normal gastric anatomy group. The rate of curative resection and incident rates of complications were not significantly different between the groups. In the altered gastric anatomy group, the rate of complete en bloc resection was significantly lower when a lesion had spread across an anastomotic site and/or a suture line (P?=?0.0372). Furthermore, duration of ESD was significantly longer (P?=?0.0276), and resection efficiency was significantly lower (13 mm²/min, P?=?0.0283), when treating lesions with an anastomotic site and/or a suture line than when treating isolated lesions.

Conclusions

Outcome of ESD for cancer of the operated stomach compares with that in normal stomach anatomy. Anastomotic site/suture line within a lesion influenced the ESD procedure.     

The value of diagnostic endoscopic submucosal dissection for patients with clinical submucosal invasive early gastric cancer

Background

The standard treatment for clinical submucosal invasive (cT1b) early gastric cancer is gastrectomy. However, Japanese gastric cancer treatment guidelines list endoscopic submucosal dissection (ESD) as an option for treating limited early gastric cancer cases. ESD can be curative depending on the pathological characteristics of resected specimens. Thus, we aimed to clarify the benefits and disadvantages of preceding ESD for early gastric cancer.

Methods

We retrospectively analyzed patients who underwent ESD or curative gastrectomy for cT1b gastric cancer with differentiated adenocarcinoma 30 mm or less in diameter. Patients who underwent ESD irrespective of undergoing gastrectomy were assigned to the ESD group (n = 107), and those who underwent gastrectomy without undergoing ESD were assigned to the non-ESD group (n = 181). Clinicopathological characteristics were assessed, and the short-term and long-term outcomes of patients were compared.

Results

The criteria for curative resection were satisfied by 83 patients (28.8%), and preceding ESD did not affect the surgical outcomes of gastrectomy. Two patients (1.9%) who underwent ESD had an unscheduled total gastrectomy. The en bloc and complete resection rates of ESD were 99.0% and 84.1% respectively. Nine patients (8.4%) experienced intraprocedure perforation and postprocedure bleeding caused by ESD. Overall survival (hazard ratio 1.38; P = 0.302) and cause-specific survival (hazard ratio 0.96; P = 0.944) were comparable between groups.

Conclusions

The stomach was preserved in 28.8% of patients, and preceding ESD did not show obvious disadvantages. Therefore, diagnostic ESD should be considered as an initial treatment for limited cT1b gastric cancer cases.

     

Involvement of three or more lymph nodes predicts poor prognosis in submucosal gastric carcinoma

BACKGROUND: Multivariate analyses has shown that the status of lymph node metastasis and the depth of tumor penetration through the gastric wall are the most important prognostic factors in patients with advanced gastric carcinoma after curative operation. A clinicopathological study was carried out to clarify a simple and optimal prognostic indicator for early gastric cancer. METHODS: Retrospective analyses of 982 patients with early gastric cancer (562 with mucosal [M] and 420 with submucosal [SM] tumor) treated by gastrectomy with D2 lymph node dissection were performed. RESULTS: The incidence of lymph node metastasis from M and SM tumors was 2.5% (14/562) and 20.2% (85/420), respectively. There were no apparent prognostic indicators in patients with M tumors. In patients with SM tumors, the cancer-specific 5-year survival of those with lymph node metastasis was significantly lower than that of those without such metastasis (77.6% vs 98.2%; P < 0.001). An sharp decrease in survival was seen between patients with two positive nodes and those with three positive nodes, and the cancer-specific 5-year survival rate of patients with three or more metastatic lymph nodes was significantly lower than that of those with one or two nodes (P < 0.001; univariate analysis). Multivariate analysis revealed that the involvement of three or more lymph nodes was the sole independent prognostic determinant (P = 0.016); the level of nodal metastasis was not an independent prognostic factor (P = 0.384). All patients with N2 lymph node echelons (according to the Japanese Research Society for Gastric Cancer classification of the draining lymph nodes of the stomach) in the group with one or two positive nodes survived for more than 5 years. CONCLUSION: The sole independent prognostic factor in SM gastric cancer is the involvement of three or more metastatic lymph nodes. We suggest that this simple prognostic indicator for the follow-up of early gastric cancer, and this could lead to potentially effective adjuvant chemotherapy.