Outcomes of Endoscopic Submucosal Dissection for Subepithelial Lesions Localized Within the Submucosa, Including Neuroendocrine Tumors: A Multicenter Prospective Study
| Autor: | Nobuya Kobayashi, Keiichi Okano, Shintaro Fujihara, Taiga Chiyo, Yoshio Ikeda, Hideki Kobara, Koji Fujita, Noriko Nishiyama, Tatsuo Yachida, Yasuyuki Suzuki, Joji Tani, Hirohito Mori, Yoichi Miyaoka, Takayoshi Yamada, Masashi Takata, Tsutomu Masaki |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Neoplasm Residual Endoscopic Mucosal Resection Population Rectum Neuroendocrine tumors 03 medical and health sciences Postoperative Complications 0302 clinical medicine Japan Stomach Neoplasms Submucosa Intestinal Neoplasms Outcome Assessment Health Care Humans Medicine Intestinal Mucosa Prospective cohort study education Neoplasm Staging education.field_of_study business.industry Stomach Gastroenterology Middle Aged medicine.disease Surgery Neuroendocrine Tumors medicine.anatomical_structure 030220 oncology & carcinogenesis Cohort Duodenum Female 030211 gastroenterology & hepatology Neoplasm Recurrence Local business |
| Zdroj: | Journal of Gastrointestinal and Liver Diseases. 29:41-49 |
| ISSN: | 1842-1121 1841-8724 |
| DOI: | 10.15403/jgld-510 |
| Popis: | Background and Aims: Endoscopic submucosal dissection (ESD) seems to be a reasonable option for gastrointestinal subepithelial lesions (SELs) localized within the submucosa. Indications for ESD include small neuroendocrine tumors (NETs) and indeterminate SELs. However, the prospective data regarding ESD and surveillance remain unclear. This study was performed to prospectively investigate the outcomes of ESD, including organ-specific outcomes and the mid-term prognosis. Methods: This prospective multicenter study included 57 patients who underwent ESD for SELs localized within the submucosa [definite NETs (n = 42) and indeterminate SELs (n = 15)]. The efficacy and safety of ESD were evaluated in the whole cohort and in subgroups (NETs and indeterminate SELs). All patients were followed up. Results: The rates of en bloc resection, curative resection, and complications were 98.2%, 66.7%, and 7.7% for the overall population (n=57); 100%, 61.9%, and 2.4% for NETs (n=42); and 93.3%, 80.0%, and 20.0% for indeterminate SELs (n=15), respectively. The rates of curative resection for NETs were poorer in the stomach (20%, n=5) and duodenum (33%, n=3) than in the rectum (71%, n=34). Including 11 of 16 patients with NETs who underwent a conservative approach resulting in non-curative resection, no patients developed tumor recurrence during the follow-up period (median, 24.5 months; range, 1–60 months). ESD followed by surveillance demonstrated acceptable mid-term outcomes for non-curative NETs. Conclusions: ESD can be an efficient therapy for SELs localized within the submucosa. However, gastric and duodenal ESD for NETs may be limited in terms of its curative and technical aspects. Clinicians should be aware of the potential complications of ESD for indeterminate SELs. |
| Databáze: | OpenAIRE |
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