Comparison of the Clinicopathological Characteristics and Results of Endoscopic Submucosal Dissection for Esophagogastric Junction and Non-Junctional Cancers

被引:61
|
作者
Hoteya, Shu [1 ]
Matsui, Akira [1 ]
Iizuka, Toshiro [1 ]
Kikuchi, Daisuke [1 ]
Yamada, Akihiro [1 ]
Yamashita, Satoshi [1 ]
Furuhata, Tsukaka [1 ]
Domon, Kaoru [1 ]
Nakamura, Masanori [1 ]
Mitani, Toshifumi [1 ]
Ogawa, Osamu [1 ]
Kasie, Mitsuru [1 ]
机构
[1] Toranomon Gen Hosp, Dept Gastroenterol, Minato Ku, Tokyo 1058470, Japan
关键词
Endoscopic submucosal dissection; Barrett's adenocarcinoma; Esophagogastric junctional cancer; Submucosal invasion; Lymphovascular invasion; Subepithelial invasion; CONVENTIONAL MUCOSAL RESECTION; EN-BLOC RESECTION; SUPERFICIAL ADENOCARCINOMA; SODIUM HYALURONATE; GASTRIC-CANCER; TUMORS; EMR;
D O I
10.1159/000343934
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Esophagogastric junction (EGJ) cancers are not only located in regions anatomically difficult for endoscopic submucosal dissection (ESD), but they also have higher clinicopathological malignant potential than non-junctional gastric cancers (NJC). Despite this, no ESD-based comparative studies of junctional cancer (JC) and NJC have been conducted to date. The aims of this study were to clarify the clinicopathological characteristics of EGJ cancers and the short- and long-term outcomes after ESD. Methods: Between April 2005 and December 2010, ESD was performed on 1,463 lesions that were divided into the following three groups: Barrett's adenocarcinoma (BA; n = 25); JC (n = 103), and NJC (n = 1,335). They were assessed for short-term outcomes, clinicopathological malignancy and long-term outcomes. Results: Rates of complete and curative resection were significantly lower for BA than for JC and NJC (64.0 vs. 96.1 and 96.0%; and 48.0 vs. 80.6 and 85.8%, respectively). The perforation rate was significantly higher for BA than for JC and NJC (20.0 vs. 2.9 and 2.7%). Clinicopathologically, submucosal invasion rates were higher in BA and JC than in NJC (32.0 and 30.1 vs. 13.6%), and positive rates of lymphatic and/or vascular invasion were remarkably higher in BA and JC versus NJC (24.0 vs. 9.7 vs. 4.8%, respectively). The 5-year survival rate in all patients with curative resection was 100%. Conclusion: This study confirmed the technical and theoretical validity of ESD for EGJ as a diagnostic treatment. However, we have to pay attention to the high rates of submucosal and lymphovascular invasive malignant potential of these cancers. Copyright (C) 2013 S. Karger AG, Basel
引用
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页码:29 / 33
页数:5
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