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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2021, Vol. 08 ›› Issue (03) : 119 -124. doi: 10.3877/cma.j.issn.2095-7157.2021.03.007

综述

早期胃癌内镜下切除术后的复发及治疗现状
李宝1, 柴宁莉1, 令狐恩强1,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心消化内科医学部
  • 收稿日期:2021-06-23 出版日期:2021-08-15
  • 通信作者: 令狐恩强
  • 基金资助:
    国家重点研发计划(2016YFC1303601)

Recurrence and treatment of early gastric cancer after endoscopic resection

Bao Li1, Ningli Chai1, Enqiang Linghu1,†()   

  1. 1. Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2021-06-23 Published:2021-08-15
  • Corresponding author: Enqiang Linghu
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李宝, 柴宁莉, 令狐恩强. 早期胃癌内镜下切除术后的复发及治疗现状[J]. 中华胃肠内镜电子杂志, 2021, 08(03): 119-124.

Bao Li, Ningli Chai, Enqiang Linghu. Recurrence and treatment of early gastric cancer after endoscopic resection[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2021, 08(03): 119-124.

随着内镜技术的发展和进步，内镜下切除术已成为早期胃癌治疗的首选方式，与传统外科手术比较有相当的长期生存率，但是随访过程中肿瘤的复发及复发后的治疗方式选择仍有一定争议。目前多依据复发发生的时间及与原发病变的位置关系对复发进行分类，补充外科手术或内镜下再次切除是复发病变治疗可选择的主要方式，也具有一定的临床安全性和有效性。本文将从内镜下切除术后复发的定义及分类、复发的影响因素、治疗选择等方面对当前复发及治疗的现状进行梳理，以期对早期胃癌内镜下切除术后复发病变的随访管理及个性化治疗提供有价值的参考。

关键词: 早期胃癌, 内镜下切除术, 复发, 治疗

With the development and advancement of endoscopic technique, endoscopic resection has been applied widely to the treatment of early gastric cancer, which has a similar long-term survival rate compared with traditional surgery. However, the recurrence of tumors during follow-up and the selection of treatment methods after recurrence are still inconclusive. At present, recurrence is mostly classified according to the time of recurrence and the distance with the location of the primary lesion. Supplementary surgery or repeated endoscopic resection is the main treatment of recurrent lesions, which also have definite safety and effectiveness. In this paper, the definition and classification of recurrence after endoscopic resection, the influencing factors of recurrence and treatment of recurrence were reviewed, in order to provide valuable reference for the follow-up management and individualized treatment of recurrence after endoscopic resection.

Key words: Early gastric cancer, Endoscopic resection, Recurrence, Treatment
表1 内镜下切除术后复发的分类及定义
复发分类 定义
残留 术后6个月内原切除部位以及周围1 cm内病理发现肿瘤病灶
局部复发 术后6个月以上原切除部位以及周围1 cm内发现肿瘤病灶
同时性癌 早期胃癌内镜治疗后12个月内内镜下发现新的病灶
异时性癌 早期胃癌治疗后，超过12个月后发现新的病灶
表2 2006~2018年内镜下切除术后残留或局部复发病变再次ESD治疗研究汇总发表
年份 作者 文献类型 例数(例) 研究对象 间隔时间 整块切除率(%) 完全切除率(%) 不良反应 随访时间 结果
2006 Yokoi等[35] 回顾性 46 EMR术后局部复发 - 89.1 76 4例穿孔 43月 无复发
2007 Fujishiro等[50] 回顾性 10 7例完全ESD术后局部复发；3例不完全ESD术 859 d 100 90 无 21.4月 无复发
2012 Bae等[36] 回顾性 16 ESD术后水平切缘阳性 (5±3)d 93.8 93.8 1例出血和穿孔 22月 1例异时性复发
2012 Kikuchi等[51] 回顾性 8 ESD术后水平切缘阳性 (8.4±3.2)d 100 87.5 无 896 d 1例异时性复发
2013 Sekiguchi等[37] 回顾性 95 ER术后局部复发 12月 90.5 84.2 6例穿孔 76.4月 3例局部复发
2013 Shimamura等[52] 回顾性 5 ESD术后局部复发 14月 100 100 无 48月 无复发
2013 Higashimaya等[53] 回顾性 12 10例ESD术水平边缘阳性；2例ESD中断未完成 (9.5±6.6)月 100 91.2 无 (13.9±7.8)月 无复发
2014 Hoteya等[38] 回顾性 26 11例ESD术后水平切缘阳性 (9±3)d 100 100 无 (39.2±25.8)月 无复发
        15例ESD术后局部复发 (685 ±501)d - 86.7 无 (33.3±30.1)月 无复发
2018 Jung等[39] 回顾性 28 6例ESD术后水平切缘阳性立即补充2次ESD 6.5 d 100 100 无 - 1例异时性复发
        8例ESD术后水平切缘阳性；创面愈合后补充2次ESD 129 d 100 100 无    
        14例ESD术后局部复发 712.8 d 85.7 78.6 1例出血；1例吸入性肺炎    
[1]
Sung H,，Ferlay J,，Siegel RL，et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin，2021，71(3): 209-249.
[2]
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition) [J]. Gastric cancer, 2021, 24(1): 1-21.
[3]
北京市科委重大项目《早期胃癌治疗规范研究》专家组. 早期胃癌内镜下规范化切除的专家共识意见(2018，北京)[J]. 中华消化内镜杂志，2019，36(6): 381-392.
[4]
Gotoda T,，Kondo H,，Ono H，et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases[J]. Gastrointest Endosc，1999，50(4): 560-563.
[5]
Zhao Y,，Wang C. Long-Term Clinical Efficacy and Perioperative Safety of Endoscopic Submucosal Dissection versus Endoscopic Mucosal Resection for Early Gastric Cancer: An Updated Meta-Analysis [J]. Biomed Res Int，2018，2018: 3152346.
[6]
Ahn JY,，Jung HY,，Choi KD，et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications[J]. Gastrointest Endosc，2011，74(3): 485-493.
[7]
Fan T,，Sun Q,，Cao S，et al. Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications[J]. BMC Gastroenterol，2021，21(1): 119.
[8]
Ono H,，Yao K,，Fujishiro M，et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition)[J]. Dig Endosc, 2021，33(1): 4-20.
[9]
Nasu J,，Doi T,，Endo H，et al. Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection[J]. Endoscopy，2005，37(10): 990-993.
[10]
Yoo JH,，Shin SJ,，Lee KM，et al. How can we predict the presence of missed synchronous lesions after endoscopic submucosal dissection for early gastric cancers or gastric adenomas？[J]. J Clin Gastroenterol，2013，47(2): e17-22.
[11]
Nakajima T, Oda I,，Gotoda T, et al. Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance？[J]. Gastric Cancer，2006，9(2): 93-98.
[12]
Abe S,，Oda I,，Minagawa T，et al. Metachronous Gastric Cancer Following Curative Endoscopic Resection of Early Gastric Cance[J]. Clin Endosc，2018，51(3): 253-259.
[13]
Park SE,，Kim SH,，Kim SG，et al. Local or extragastric recurrence after incomplete endoscopic submucosal dissection of early gastric cancer: risk factors and the role of CT[J]. Abdom Radiol (NY), 2018，43(12): 3250-3259.
[14]
Lee JY,，Cho KB,，Kim ES，et al. Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cance[J]. World J Gastrointest Endosc，2016，8(7): 330-337.
[15]
Nam HS,，Choi CW,，Kim SJ，et al. Endoscopic predictive factors associated with local recurrence after gastric endoscopic submucosal dissection[J]. Scand J Gastroenterol，2018，53(8): 1000-1007.
[16]
Lee JH,，Kim JH,，Kim DH，et al. Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer？[J]. J Gastric Cancer，2010，10(4): 182-187.
[17]
Sunagawa H,，Kinoshita T,，Kaito A，et al. Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases[J]. Surg Today，2017，47(2): 202-209.
[18]
Yajima H,，Omura N,，Takahashi N，et al. Additional gastrectomy after endoscopic mucosal resection for early gastric cance[J]. Int Surg，2015，100(1): 169-172.
[19]
Lee H,，Yun WK,，Min BH，et al. A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cance[J]. Surg Endosc，2011，25(6): 1985-1993.
[20]
Choi JY,，Jeon SW,，Cho KB，et al. Non-curative endoscopic resection does not always lead to grave outcomes in submucosal invasive early gastric cance[J]. Surg Endosc，2015，29(7): 1842-1849.
[21]
Abdelfatah MM,，Barakat M,，Ahmad D，et al. Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer: a systematic review and meta-analysis[J]. Eur J Gastroenterol Hepatol，2019，31(4): 418-424.
[22]
Jang MY,，Cho JW,，Oh WG，et al. Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection[J]. Korean J Intern Med，2013，28(6): 687-693.
[23]
Sekiguchi M,，Suzuki H,，Oda I，et al. Risk of recurrent gastric cancer after endoscopic resection with a positive lateral margin[J]. Endoscopy，2014，46(4): 273-278.
[24]
Park JC,，Lee SK,，Seo JH，et al. Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience[J]. Surg Endosc，2010，24(11): 2842-2849.
[25]
黄戬，章庆伟，张昕恬，等. 早期胃癌内镜下切除后复发及异时癌的影响因素探究 [J]. 中华消化内镜杂志，2018，7(35): 492-496.
[26]
Takenaka R,，Kawahara Y,，Okada H，et al. Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection[J]. Gastrointest Endosc，2008, 68(5): 887-894.
[27]
Kim TK,，Kim GH,，Park DY，et al. Risk factors for local recurrence in patients with positive lateral resection margins after endoscopic submucosal dissection for early gastric cance[J]. Surg Endosc，2015，29(10): 2891-2898.
[28]
Cha JH,，Jang JS. Correlation between healing type of lesion and recurrence in gastric neoplastic lesions after endoscopic submucosal dissection[J]. Turk J Gastroenterol，2020，31(1): 36-41.
[29]
Park WY,，Lee SJ,，Kim YK，et al. Occurrence of metachronous or synchronous lesions after endoscopic treatment of gastric epithelia dysplasia- impact of histologic features of background mucosa[J]. Pathol Res Pract，2018，214(1): 95-99.
[30]
Nam HS,，Kim HW,，Choi CW，et al. Characteristics of overlooked synchronous gastric epithelial neoplasia after endoscopic submucosal dissection[J]. Medicine，2018，97(39): e12536.
[31]
Maehata Y,，Nakamura S,，Fujisawa K，et al. Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cance[J]. Gastrointest Endosc，2012，75(1): 39-46.
[32]
Venerito M,，Malfertheiner P. Preneoplastic conditions in the stomach: always a point of no return？[J]. Dig Dis，2015，33(1): 5-10.
[33]
Kim JL,，Kim SG,，Kim J，et al. Clinical Outcomes of Metachronous Gastric Cancer after Endoscopic Resection for Early Gastric Cance[J]. Gut Liver，2020，14(2): 190-198.
[34]
Lee MW,，Kim GH. Metachronous Gastric Cancer: Another Hurdle for Successful Endoscopic Treatment for Early Gastric Cancer？[J]. Gut Liver，2020，14(2): 145-147.
[35]
Yokoi C,，Gotoda T,，Hamanaka H，et al. Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection[J]. Gastrointest Endosc，2006，64(2): 212-218.
[36]
Bae SY,，Jang TH,，Min BH，et al. Early additional endoscopic submucosal dissection in patients with positive lateral resection margins after initial endoscopic submucosal dissection for early gastric cance[J]. Gastrointest Endosc，2012，75(2): 432-436.
[37]
Sekiguchi M,，Suzuki H,，Oda I，et al. Favorable long-term outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection[J]. Endoscopy，2013，45(9): 708-713.
[38]
Hoteya S,，Iizuka T,，Kikuchi D，et al. Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection[J]. Gastric Cancer，2014，17(4): 697-702.
[39]
Jung DH,，Youn YH,，Kim JH. Secondary endoscopic submucosal dissection for locally recurrent or incompletely resected gastric neoplasms[J]. World J Gastroenterol，2018，24(33): 3776-3785.
[40]
Lee KM,，Kim YB,，Sin SJ，et al. Argon plasma coagulation with submucosal saline injection for gastric adenoma on outpatient basis[J]. Dig Dis Sci，2009，54(12): 2623-2628.
[41]
Kitamura T,，Tanabe S,，Koizumi W，et al. Argon plasma coagulation for early gastric cancer: technique and outcome[J]. Gastrointest Endosc，2006，63(1): 48-54.
[42]
Oh S,，Kim SG,，Choi JM，et al. Ablation of residual gastric tumor by argon plasma coagulation after endoscopic resection[J]. Surg Endosc，2017，31(3): 1093-1100.
[43]
Kim HW,，Kim JH,，Park JC，et al. Additive endoscopic resection may be sufficient for patients with a positive lateral margin after endoscopic resection of early gastric cance[J]. Gastrointest Endosc，2017，86(5): 849-856.
[44]
Nagano H,，Ohyama S,，Fukunaga T，et al. Indications for gastrectomy after incomplete EMR for early gastric cance[J]. Gastric Cancer，2005，8(3): 149-154.
[45]
Tian YT,，Ma FH,，Wang GQ，et al. Additional laparoscopic gastrectomy after noncurative endoscopic submucosal dissection for early gastric cancer: A single-center experience[J]. World J Gastroenterol，2019，25(29): 3996-4006.
[46]
Hatta W,，Gotoda T,，Oyama T，et al. Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multi-center retrospective study in Japan[J]. J Gastroenterol，2017，52(2): 175-184.
[47]
令狐恩强，冯佳，马晓冰，等. 内镜下射频消融术治疗食管和胃低级别上皮内瘤变的临床研究 [J/CD]. 中华胃肠内镜电子杂志，2015，2(1): 14-17.
[48]
王楠钧，柴宁莉，令狐恩强，等. 内镜下射频消融术治疗胃低级别上皮内瘤变的临床研究[J/CD]. 中华胃肠内镜电子杂志，2020，7(3): 117-120.
[49]
Leung WK,，Tong DK,，Leung SY，et al. Treatment of Gastric Metaplasia or Dysplasia by Endoscopic Radiofrequency Ablation: A Pilot Study[J]. Hepatogastroenterology，2015，62(139): 748-751.
[50]
Fujishiro M,，Goto O,，Kakushima N，et al. Endoscopic submucosal dissection of stomach neoplasms after unsuccessful endoscopic resection[J]. Dig Liver Dis，2007，39(6): 566-571.
[51]
Kikuchi D,，Iizuka T,，Hoteya S，et al. Safety and efficacy of secondary endoscopic submucosal dissection for residual gastric carcinoma after primary endoscopic submucosal dissection[J]. Digestion，2012，86(4): 288-293.
[52]
Shimamura Y,，Ishii N,，Nakano K，et al. Repeat endoscopic submucosal dissection for recurrent gastric cancers after endoscopic submucosal dissection[J]. World J Gastrointest Endosc, 2013，5(12): 600-604.
[53]
Higashimaya M,，Oka S,，Tanaka S，et al. Endoscopic submucosal dissection for residual early gastric cancer after endoscopic submucosal dissection[J]. Gastrointest Endosc，2013，77(2): 298-302.
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