Feasibility and surgery indications of endoscopic submucosal dissection for gastric cancers / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the feasibility and indications of endoscopic submucosal dissection (ESD) by analyzing the early gastric cancer cases.Methods All the pathological materials of radical gastric resections in Huashan hospital from 2007 to 2011 were retrieved and the EGC cases were selected.All the cases in EGC group which met the extended ESD criteria were reviewed.Extended ESD criteria were cited from Treatment guidelines for gastric cancer in Japan edited by JGCA in 2001.The risk factors relevant with regional metastasis,such as invasive depth and differentiation degrees,were also analysed.Results In the recent five years,there were 1159 cases of gastric cancer undergoing radical gastrectomy in Huashan hospital including 210 EGC.According to the extended criteria of JGCA,151 cases could be candidates for ESD while 126 cases could be candidates for ESD according to the typical criteria for ESD.The local metastases of lymphatic or vascular involvement for mucosa cancer,muscularis mucosae cancer,sm1 and sm2 cancer were 6.75％,15.00％,23.25％,and 39.62％ respectively (P ＜0.05).Twenty-five cases had local metastases that met the extended criteria for ESD.Within the 210 EGC cases,the local metastases of differentiated type and undifferentiated type were 13.95％ and 47.37％ respectively (P ＜ 0.05).Conclusion Most EGC cases undergoing radical gastrectomy can be cured by ESD.Its metastases are highly correlated with invasion depth and differentiation,so indications of ESD should be assessed.