미분화 조기위암에서 내시경 점막하박리술의 치료 성적 (Therapeutic Outcomes of Endoscopic Submucosal Dissection in Undifferentiated-type Early Gastric Cancer)

서지정보

· 발행기관 : 대한소화기학회
· 수록지 정보 : 대한소화기학회지 / 61권 / 4호 / 196 ~ 202페이지
· 저자명 : 최문한, 홍수진, 한재필, 송정엽, 김대용, 서성우, 하지수, 이윤나, 고봉민, 이문성

초록

목적: 내시경 점막하박리술은 조기위암의 표준 치료로 받아들여지고 있다. 하지만, 미분화 조기위암에 대한 내시경 점막하박리술의 적응증은 아직 논란이 있다. 이번 연구에서는 확대적응증에 의한 미분화 조기위암에서 내시경 점막하박리술의치료 성적에 대해 파악하고자 하였다.
대상 및 방법: 순천향대학교 의과대학 부천병원에서 미분화조기위암 환자 81명을 대상으로 82병변에 대해 내시경 점막하박리술을 시행하였다. 치료 성적에 대해 절제 방법(일괄 절제, 분할 절제), 완전 절제율, 합병증, 재발률에 대해 조사하였다.
결과: 일괄 절제율과 완전 절제율은 각각 87.8% (72/82)과80.5% (66/82)였다. 반지세포암종에서 저분화 선암종과 반지세포를 동반한 저분화 선암종에 비해 높은 완전 절제율을 보였으나, 통계학적 의미는 없었다(89.3% vs. 75.0%, 76.7%; p=0.347). 저분화 선암종, 반지세포암종, 반지세포를 동반한저분화 선암종에서 측면절제면 양성이 확인된 경우는 각각12.5%, 3.6%, 13.3%였다(p=0.395). 기저절제면 양성이 확인된 경우는 각각 12.5%, 3.6%, 10.0%였다(p=0.485). 평균 37.4 개월의 추적기간 동안 재발률은 3.0%였다.
결론: 확대 적응증에 의한 미분화 조기위암에서의 내시경 점막하박리술은 유용한 치료가 될 것으로 생각되나, 장기적이고대규모의 연구가 필요하겠다.

영어초록

Background/Aims: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment of early gastric cancer (EGC). However, the indication of ESD in undifferentiated-type EGC was controversial. The aim of this study was to evaluate the therapeutic outcomes of ESD in undifferentiated-type EGC according to expanded indication.
Methods: At Soonchunhyang University Bucheon Hospital, a total of 82 lesions in 81 patients with undifferentiated-type EGC were treated with ESD. The therapeutic outcomes of ESD were evaluated by resection method (en bloc resection; piecemeal resection), histologic curative resection, complications and recurrence rates after ESD.
Results: The rate on en bloc resection and complete resection rate were 87.8% (72/82) and 80.5% (66/82), respectively. In signet ring cell carcinoma, the complete resection rate was higher than those in poorly differentiated adenocarcinoma and poorly differentiated adenocarcinoma with signet ring cell features, but there was no statistical significance (89.3% vs. 75.0%, 76.7%; p=0.347). The lateral margin positivity rate in poorly differentiated adenocarcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma with signet ring cell features were 12.5%, 3.6% and 13.3%, respectively (p=0.395). The vertical margin positivity rate were 12.5%, 3.6% and 10.0%, respectively (p=0.485). The overall recurrence rate was 3.0% during a mean follow-up period of 37.4 months.
Conclusions: ESD may be considered as a feasible treatment for undifferentiated-type EGC according to expanded indication. The therapeutic outcome of ESD in undifferentiated-type EGC is likely to be favorable, though further longer follow-up studies are needed.

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