Endoscopic Submucosal Dissection Compared to Laparoscopic Gastrectomy for Treatment of Early Gastric Cancer and a Prospective Randomized Trial
Refereed conference paper presented and published in conference proceedings


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摘要Objective
The objective of the study is to compare clinical, oncological and immunological outcomes of endoscopic submucosal dissection (ESD) against laparoscopic assisted gastrectomy (LAG) for treatment of early gastric cancer.

Method
All patients with endoscopic diagnosis of early gastric cancer (EGC) and biopsy confirmed to be high grade dysplasia or adenocarcinoma were recruited. They received staging investigations including image enhanced endoscopy, EUS and CT and those predicted to be T1a (intramucosal) neoplasia were randomly assigned to receive ESD or LAG. ESD were performed according to the previously reported procedure, while LAG were performed with D1+ß lymphadenectomy. The baseline demographics, clinical perioperative outcomes, immunological and oncological outcomes were compared between the two groups. Primary outcome was rate of complication after operation.

Outcomes
From 2011 to 2016, 36 patients with early gastric cancers were randomly assigned to receive ESD (n = 18) or LAG (n = 18). There was no difference between the two groups in terms of age, gender, ASA grade and baseline demographics (Table 1). ESD was associated with significantly shorter operative time (109.4 ± 55.4 vs 266.2 ± 47.8 mins, p < 0.001), hospital stay (4 (3-6) vs 8 (4-14) days; p < 0.001) and lower complication rate (1 (5.6%) vs 7 (38.9%); p = 0.041). There was no mortality at 30 days for the two groups, while those in ESD group tolerated full diet earlier (2 (1-5) vs 5 (3-12) days; p < 0.001). Patients who received ESD had significantly lower level of CRP as well as VAS pain scores on postoperative days 1,2, 3 and 7 when compared to LAG. The median follow-up was 41.5 months for ESD group and 36 months for LAG group, and there was no difference in the cancer recurrence and overall survival. 27.8% of patients required re-intervention after ESD.

Conclusion
Our prospective randomized study showed that patients treated by ESD had significantly lower complication rate and better perioperative outcomes when compared laparoscopic gastrectomy. ESD should be the first line treatment for intramucosal early gastric cancers.
著者Chiu PWY, Teoh AY, Ng EK, Wong VW, Yip HC, Wu JC, Liu SY, Wong SK, Chan FK, Sung JJ, Lau JY
會議名稱Digestive Disease Week 2017
會議開始日07.05.2017
會議完結日09.05.2017
會議地點Chicago, Illinois
會議國家/地區美國
會議論文集題名Gastrointestinal Endoscopy
出版作品名稱GASTROINTESTINAL ENDOSCOPY
出版年份2017
月份5
卷號85
期次5 Supplement
出版社Elsevier
頁次AB70 - AB71
國際標準期刊號0016-5107
語言英式英語
Web of Science 學科類別Gastroenterology & Hepatology;Gastroenterology & Hepatology

上次更新時間 2020-13-08 於 05:12