Endoscopic submucosal dissection in early gastric cancer in elderly patients and comorbid conditions  

作　　者：Tsutomu Nishida Motohiko Kato Toshiyuki Yoshio Tomofumi Akasaka Teppei Yoshioka Tomoki Michida Masashi Yamamoto Shiro Hayashi Yoshito Hayashi Masahiko Tsujii Tetsuo Takehara 

机构地区：[1]Department of Gastroenterology, Toyonaka Municipal Hospital [2]Department of Gastroenterology, National Hospital Organization, Tokyo Medical Center [3]Division of Gastroenterology, Cancer Institute Hospital,Tokyo [4]Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases [5]Department of Gastroenterology and Hepatology, Osaka University of Graduate School of Medicine [6]Department of Gastroenterology, Teikyo University Medical Center

出　　处：《World Journal of Gastrointestinal Endoscopy》2015年第5期524-531,共8页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：The prognosis of early gastric cancer(EGC) is good if there is no concomitant lymph node metastasis. Therefore, the early detection of EGC is important to improve the prognosis of patients with gastric cancer. In Japan, 40% to 50% of all gastric cancers are EGC, and endoscopic submucosal dissection(ESD) is widely accepted as a local treatment for these lesions, particularly for large lesions that at one time were an indication for gastrectomy because of the difficulty of en-bloc resection. Consequently, this procedure can preserve the entire stomach and the patient's postoperative quality of life. ESD has become a general technique with improved procedures and devices, and has become the preferred treatment for EGC rather than gastrectomy. Therefore, ESD may demonstrate many advantages in patients who have several comorbidities, particularly elderly population, patients taking antithrombotic agents, or patients with chronic kidney disease, or liver cirrhosis. However, it is not yet clear whether patients with both EGC and comorbidities are feasible candidates for ESD and whether they would consequently be able to achieve a survival benefit after ESD. In this review, we discuss the clinical problems of ESD in patients with EGC and those comorbid conditions.The prognosis of early gastric cancer （EGC） is goodif there is no concomitant lymph node metastasis.Therefore, the early detection of EGC is important toimprove the prognosis of patients with gastric cancer.In Japan, 40% to 50% of all gastric cancers areEGC, and endoscopic submucosal dissection （ESD） iswidely accepted as a local treatment for these lesions,particularly for large lesions that at one time were anindication for gastrectomy because of the difficultyof en-bloc resection. Consequently, this procedurecan preserve the entire stomach and the patient＇spostoperative quality of life. ESD has become a generaltechnique with improved procedures and devices, andhas become the preferred treatment for EGC ratherthan gastrectomy. Therefore, ESD may demonstratemany advantages in patients who have several comorbidities,particularly elderly population, patients takingantithrombotic agents, or patients with chronic kidneydisease, or liver cirrhosis. However, it is not yet clearwhether patients with both EGC and comorbidities arefeasible candidates for ESD and whether they wouldconsequently be able to achieve a survival benefitafter ESD. In this review, we discuss the clinical problemsof ESD in patients with EGC and those comorbidconditions.

关 键 词：Endoscopic SUBMUCOSAL DISSECTION Gastriccancer Elderly PERSON ANTITHROMBOTIC agents LIVERCIRRHOSIS Chronic KIDNEY disease 

分 类 号：R735.2[医药卫生—肿瘤]