Feasibility of endoscopic submucosal dissection for gastric and colorectal lesions: Initial experience from the Gastrocentro - Unicamp

OBJECTIVE: Endoscopic submucosal dissection is a technique developed in Japan for en bloc resection with a lower rate of recurrence. It is considered technically difficult and performed only in specialized centers. This study sought to report the initial experience from the Gastrocentro - Campinas State University for the treatment of gastric and colorectal lesions by endoscopic submucosal dissection. MATERIALS AND METHODS: The guidelines of the Japanese Association of Gastric Cancer were used as evaluative criteria. For colorectal lesions, the recommended standards proposed by Uraoka et al. and Saito et al. were employed. The practicability of the method, the development of complications and histological analysis of the specimens were evaluated. RESULTS: Sixteen patients underwent endoscopic submucosal dissection from June 2010 to April 2011; nine patients were treated for gastric lesions, and seven were treated for colorectal lesions. The average diameter of the gastric lesions was 28.6 mm, and the duration of resection was 103 min without complications. All lesions presented lesion-free margins. Of the seven colorectal tumors, four were located in the rectum and three were located in the colon. The average size was 26 mm, and the average procedure time was 163 min. Two complications occurred during the rectal resection procedures: perforation, which was treated with an endoscopic clip, and controlled bleeding. One of the lesions presented a compromised lateral margin without relapse after 90 days. Depth margins were all free of lesions. CONCLUSION: Endoscopic submucosal dissection at our institution achieved high success rates, with few complications in preliminary procedures. The procedure also made appropriate lesion staging possible.

Factores morfológicos asociados al pronóstico de pacientes operados por cáncer gástrico incipiente / Pathological features associated with survival in early gastric cancer

Background: Early gastric cancer corresponds to those tumors that only involve mucosa and submuco-sa. It is associated with a high survival rate. Aim: To determine pathological factors associated with survival in early gastric cancer. Material and Methods: Analysis of pathological records of 106 patients, with a median age of 63 years (60 percent> males), subjected to a gastrectomy for early gastric cancer. Follow up was performed according to data in the clinical records and death certificates obtained at the Chilean National Death Registry. Results: Five years global survival of patients was 91 percento. Lymph node involvement was more common among tumors bigger than 35 mm, with a low degree of differentiation and among those tumors classified as diffuse according to Lauren. Survival was significantly lower for bigger tumors, those with of a low degree of differentiation, diffuse tumors according to Lauren and those with lymph node involvement. Conclusions: Early gastric cancer has a high five years survival. Bigger tumors, those with a low degree of differentiation and those with lymph node involvement are associated with lower survival rates.

Introducción: El cáncer gástrico incipiente (CGI) es aquel que compromete la mucosa o submucosa gástrica independientemente del compromiso ganglionar linfático, estimándose su prevalencia en Chile inferior al 20 por cientoo. El objetivo de este estudio es determinar prevalencia de CGI y asociación de variables biode-mográficas y morfológicas con la supervivencia (SV) de pacientes resecados por CGI. Material y Método: Estudio de cohorte retrospectiva. Se estudiaron variables biodemográficas y morfológicas de 106 pacientes resecados por CGI entre 1986-2007. Se aplicó estadística descriptiva y analítica; confección de curvas de SV, y finalmente se aplicaron modelos de regresión logística para realizar ajuste, calcular odds ratio y sus respectivos intervalos de confianza de 95 por ciento. Resultados: 15 por ciento correspondió a CGI. La mediana de edad fue 63 años y el 60 por ciento correspondió a género masculino con una SV global a 5 años de 91 por ciento. Se observaron diferencias estadísticas significativas entre tumores mucosos y submucosos en cuanto a la localización tumoral y compromiso linfonodal junto con presentarse el compromiso nodal más frecuentemente en tumores > 35mm poco diferenciados y difusos de Lauren. El análisis multivariado identificó como factores asociados a la SV: tamaño tumoral, grado de diferenciación histológica en su variedad poco diferenciado, tipo difuso de Lauren y compromiso ganglionar linfático. Conclusiones: Se verificó una prevalencia de CGI de 15 por ciento, los que resecados presentan SV de 91 por ciento a 5 años. El compromiso linfonodal es un factor asociado a la SV; y además, se relaciona con tamaño tumoral, tipo histológico según Lauren, grado de diferenciación histológico y nivel de infiltración.

Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer: initial experience of a western center

BACKGROUND: Endoscopic submucosal dissection is a new Japanese technique characterized by en-bloc resection of the entire lesion irrespective of size, with lower local recurrence when compared to endoscopic mucosal resection. OBJECTIVE: To evaluate the feasibility, early results and complications of the endoscopic submucosal dissection technique for treating early gastric and esophageal cancer at the Endoscopic Unit of Clinics Hospital and Cancer Institute of the São Paulo University. MATERIALS AND METHODS: Twenty patients underwent endoscopic resection using the endoscopic submucosal dissection technique for early gastric or esophageal cancer. The patients were evaluated prospectively as to the executability of the technique, the short-term results of the procedure and complications. RESULTS: Sixteen gastric adenocarcinoma lesions and six esophageal squamous carcinoma lesions were resected. In the stomach, the mean diameter of the lesions was 16.2 mm (0.6-3.5 mm). Eight lesions were type IIa + IIc, four were type IIa and four IIc, with thirteen being well differentiated and three undifferentiated. Regarding the degree of invasion, five were M2, seven were M3, two were Sm1 and one was Sm2. The mean duration of the procedures was 85 min (20-160 min). In the esophagus, all of the lesions were type IIb, with a mean diameter of 17.8 mm (6-30 mm). Regarding the degree of invasion, three were M1, one was M2, one was M3 and one was Sm1. All had free lateral and deep margins. The mean time of the procedure was 78 min (20-150 min). CONCLUSION: The endoscopic submucosal dissection technique was feasible in our service with a high success rate.

Câncer gástrico precoce: uma doença curável no Brasil / Early gastric cancer: a curable disease in Brazil

Objetivo: O objetivo deste estudo foi revisar os resultados cirúrgicos e definir o perfil dos pacientes com câncer gástrico precoce (CGP) tratados em hospital universitário no Rio Grande do Sul. Método: Quarenta e quatro pacientes tratados por CGP foram estudados de forma retrospectiva. As principais variáveis em estudo foram: idade, gênero, sintomatologia, características anatomopatológicas do tumor, tratamento empregado, complicações do procedimento cirúrgico, mortalidade operatória e sobrevida aos cinco e 10 anos. Resultados: A incidência de CGP foi 8,38% dos pacientes ressecados por adenocarcinoma (44/525). Todos os pacientes foram submetidos à ressecção cirúrgica. A média de idade foi de 57,3 anos e o sexo masculino predominou com 61,4% dos casos. O sintoma mais comum foi dor ou desconforto epigástrico em 23 (52,3%) pacientes. A localização mais comum foi no terço distal do órgão em 24 (54,5%) casos. As apresentações macroscópicas mais comuns foram os tipos IIc e III. A linfadenectomia mais empregada foi a D1, em 30 (68,2%) pacientes. Quinze (34,1%) pacientes apresentaram tumor restrito à mucosa e em 29 (65,9%) a lesão invadia até a camada submucosa. Metástases linfonodais foram diagnosticadas em oito (18,2%) pacientes. Houve um (2,3%) óbito operatório e a sobrevida foi de 95,1% e 82,5% aos cinco e 10 anos, respectivamente. Conclusão: As excelentes taxas de cura dos pacientes com CGP obtidas pelos cirurgiões japoneses podem ser reproduzidas no Brasil, mesmo na presença de gânglios comprometidos, justificando esforços para aumento no diagnóstico precoce desta neoplasia em nosso meio (AU)

Objective: The aim of this study was to evaluate the results of the surgical treatment and the profile of patients diagnosed with early gastric cancer (EGC) in a tertiary care hospital in Southern Brazil. Methods: Forty-four patients who had operations for EGC were retrospectively evaluated. The main variables analyzed were: age, genre, clinical symptoms, site and stage of tumor, surgical procedure, surgical complications, operative mortality and long term survival. Results: The incidence of EGC was 8,38% of the resected patients (44/525). All patients were treated by surgical resection. The mean age at diagnosis was 57,3 years and there was a male predominance of 61,4%. Tenderness or epigastric pain was the most common clinical symptom. Tumors were typically located in the distal third of the stomach (54,5%). Macroscopically, the majority of the lesions were type IIc (45,4%) and III (25%). D1 lymphadenectomy was performed in 30 (68,2%) patients. Fifteen (34,1%) patients had intramucosal tumors and in 29 (65,9%) tumor extended into the submucosa. Eight (18,2%) patients had metastatic lymph nodes. Only 1 (2,86%) patient died of operative complications and the survival rate was 95,1% and 82,5% at five and 10 years respectively. Conclusion: The excellent results reported by Japanese surgeons in the treatment of EGC can be reproduced in Brazil, even in the presence of lymph nodes metastasis, and justify a strong support to increase this diagnosis in our country (AU)