Efficacy and Safety of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients with Comorbid Diseases
2
조회
0
다운로드
4
인용
0
참고문헌
초록
Background/Aims: Endoscopic submucosal dissection (ESD), a new and potentially curative method for treating gastrointestinal neoplasms, may have longer procedure time and the risk of complications when compared to conventional endoscopic mucosal resection. This study evaluated the efficacy and safety of ESD in patients with comorbid diseases. Methods: The outcomes of 337 patients who underwent ESD for early gastric cancer at Samsung Medical Center from April 2003 to December 2006 were analyzed retrospectively. The Charlson comorbidity scale was used to divide the patients into low-risk (no risk factor) and high-risk (at least one risk factor) groups. The outcomes and complications were compared between the high-and low- risk groups. Results: The low- and high-risk groups comprised 240 and 97 patients with mean ages of 61.1 and 64.7 years, respectively (p=0.002). Tumor location, tumor size, depth of invasion,procedure duration, and rates of en bloc resection,complete resection, complication, and recurrence did not differ significantly between the two groups (p＞0.05). Conclusions: ESD may be a safe and effective treatment for early gastric cancer in patients with comorbid diseases.
Abstract
Background/Aims: Endoscopic submucosal dissection (ESD), a new and potentially curative method for treating gastrointestinal neoplasms, may have longer procedure time and the risk of complications when compared to conventional endoscopic mucosal resection. This study evaluated the efficacy and safety of ESD in patients with comorbid diseases. Methods: The outcomes of 337 patients who underwent ESD for early gastric cancer at Samsung Medical Center from April 2003 to December 2006 were analyzed retrospectively. The Charlson comorbidity scale was used to divide the patients into low-risk (no risk factor) and high-risk (at least one risk factor) groups. The outcomes and complications were compared between the high-and low- risk groups. Results: The low- and high-risk groups comprised 240 and 97 patients with mean ages of 61.1 and 64.7 years, respectively (p=0.002). Tumor location, tumor size, depth of invasion,procedure duration, and rates of en bloc resection,complete resection, complication, and recurrence did not differ significantly between the two groups (p＞0.05). Conclusions: ESD may be a safe and effective treatment for early gastric cancer in patients with comorbid diseases.
참고문헌 (28)
- Kojima T, "Outcomeof endoscopic mucosal resection for early gastric cancer: review of the Japanese literature", Gastrointest Endosc, 48, pp.550~554 (1998)
- Soetikno R, "Endoscopic mucosal resection for early cancers of the upper gastrointestinaltract", J Clin Oncol, 23, pp.4490~4498 (2005)
- Kim JJ, "EMR for early gastric cancer in Korea: a multicenter retrospective study", Gastrointest Endosc, 66, pp.693~700 (2007)
- Lee JH, "Endoscopic mucosal resection of early gastric cancer: experiences in Korea", World J Gastroenterol, 13, pp.3657~3661 (2007)
- Gotoda T, "Endoscopic resection of early gastric cancer: the Japanese perspective", Curr Opin Gastroenterol, 22, pp.561~569 (2006)
- Gotoda T, "Endoscopic submucosal dissection of early gastric cancer", J Gastroenterol, 41, pp.929~942 (2006)
- Oka S, "Advantage of endoscopic submucosal dissection compared with EMR for early gastriccancer", Gastrointest Endosc, 64, pp.877~883 (2006)
- Watanabe K, "Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection", Gastrointest Endosc, 63, pp.776~782 (2006)
- Shimura T, "Advantages of endoscopic submucosal dissection over conventional endoscopic mucosal resection", J Gastroenterol Hepatol, 22, pp.821~826 (2007)
- Fujishiro M, "Endoscopic submucosal dissection for stomach neoplasms", World J Gastroenterol, 12, pp.5108~5112 (2006)
- McKenna RJ Sr, "Clinical aspects of cancer in the elderly: treatment decisions, treatment choices, and follow-up", Cancer, 74, pp.2107~2117 (1994)
- Matsushita I, "Should gastric cancer patients more than 80 years of age undergo surgery? Comparison with patients not treated surgically concerning prognosis and quality of life", J Clin Gastroenterol, 35, pp.29~34 (2002)
- Kunisaki C, "Comparison of surgical outcomes of gastric cancer in elderly and middle-aged patients", Am J Surg, 119, pp.216~224 (2006)
- Schlemper RJ, "Review of histological classifications of gastrointestinal epithelial neoplasia: differences in diagnosis of early carcinomas between Japanese and Western pathologists", J Gastroenterol, 36, pp.445~456 (2001)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Birim O, "Validation of the Charlson comorbidity index in patients with operated primary nonsmall cell lung cancer", Eur J Cardiothorac Surg, 23, pp.30~34 (2003)
- Ouellette JR, "Evaluation of Charlson-Age comorbidity index as predictor of morbidity and mortality in patients with colorectal carcinoma", J Gastrointest Surg, 8, pp.1061~1067 (2004)
- Wang CY, "Comparison of Charlson comorbidity index and Kaplan-Feinstein index in patients with stage I lung cancer after surgical resection", Eur J Cardiothorac Surg, 32, pp.877~881 (2007)
- Lee HJ, "Gastric cancer in Korea", Gastric Cancer, 5, pp.177~182 (2002)
- Hai-Rim Shin, "Nationwide Cancer Incidence in Korea, 1999~2001; First Result Using the National Cancer Incidence Database", Cancer Research and Treatment, 37(6), pp.325~331 (2005), 대한암학회
- Cho JY, "Indications and limitations of endoscopic mucosal resection in gastric cancer", Korean J Gastroenterol, 45, pp.3~8 (2005)
- Shiba M, "Risk factors for bleeding after endoscopic mucosal resection", World J Gastroenterol, 11, pp.7335~7339 (2005)
- Oda I, "A multicenter retrospective study of endoscopic resection for early gastric cancer", Gastric Cancer, 9, pp.262~270 (2006)
- Kakushima N, "Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population", J Gastroenterol Hepatol, 22, pp.311~314 (2007)
- Ogura K, "Efficacy and safety of endoscopic submucosal dissection for gastric cancer in patients with liver cirrhosis", Endoscopy, 40, pp.443~445 (2008)
- Kim JW, "Risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumor", Eur J Gastroenterol Hepatol, 19, pp.409~415 (2007)
- Jeon SW, "Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesions", Surg Endosc, 23, pp.1974~1979 (2009)
- Gotoda T, "Endoscopic resection of early gastric cancer", Gastric Cancer, 10, pp.1~11 (2007)