Subscribe to RSS
DOI: 10.1055/s-2007-995650
© Georg Thieme Verlag KG Stuttgart · New York
Efficacy and safety of endoscopic submucosal dissection for gastric cancer in patients with liver cirrhosis
Publication History
submitted 21 September 2007
accepted after revision 11 February 2008
Publication Date:
02 April 2008 (online)
Endoscopic submucosal dissection (ESD) has become a widely accepted method for treating gastrointestinal cancer. The aim of this study was to evaluate the efficacy and safety of ESD for gastric cancer in patients with liver cirrhosis. A total of 18 gastric cancers were treated by ESD in 15 patients with cirrhosis. The rate of en bloc resection was 88.9 % (16/18). En bloc resection with tumor-free lateral/basal margins (R0 resection) was 77.8 % (14/18). Three patients had postoperative bleeding and underwent emergency gastroscopy for hemostasis. No recurrence was observed during the median follow-up of 21.4 months, excluding three patients in whom additional endoscopic resection or surgery was carried out. ESD can be safely performed for gastric cancer in patients with cirrhosis, resulting in a high en bloc resection rate.
References
- 1 Oka S, Tanaka S, Kaneko I. et al . Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006; 64 877-883
- 2 Kakushima N, Fujishiro M, Kodashima S. et al . A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms. Endoscopy. 2006; 38 991-995
- 3 Mansour A, Watson W, Shayani V. et al . Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997; 122 730-735
- 4 Kakushima N, Fujishiro M, Kodashima S. et al . Histopathologic characteristics of gastric ulcers created by endoscopic submucosal dissection. Endoscopy. 2006; 38 412-415
- 5 Participants in the Paris Workshop . The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc. 2003; 58 S3-S43
- 6 Dixon M F. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut. 2002; 51 130-131
- 7 Japanese Gastric Cancer Association . Japanese classification of gastric carcinoma - 2nd English Edition. Gastric Cancer. 1998; 1 10-24
- 8 Sano T, Sasako M, Kinoshita T. et al . Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature. Cancer. 1993; 72 3174-3178
- 9 Isozaki H, Okajima K, Ichinona T. et al . Surgery for gastric cancer in patients with cirrhosis. Surg Today. 1997; 27 17-21
- 10 Ryu K W, Lee J H, Kim Y W. et al . Management of ascites after radical surgery in gastric cancer patients with liver cirrhosis and minimal hepatic dysfunction. World J Surg. 2005; 29 653-656
- 11 Lee J H, Kim J, Cheong J H. et al . Gastric cancer surgery in cirrhotic patients: result of gastrectomy with D2 lymph node dissection. World J Gastroenterol. 2005; 11 4623-4627
K. Ogura, MD, PhD
Department of Gastroenterology
University of Tokyo Graduate School of Medicine
7-3-1 Hongo
Bunkyo
Tokyo 113-8655
Japan
Fax: + 81-3-3814-0021
Email: keiji-tky@umin.ac.jp