KMID : 1141820230230010146
|
|
Journal of Gastric Cancer 2023 Volume.23 No. 1 p.146 ~ p.158
|
|
Endoscopic Resection of Undifferentiated Early Gastric Cancer
|
|
Hirai Yuichiro
Abe Seiichiro Makiguchi Mai Ego Sekiguchi Masau Nonaka Satoru Suzuki Haruhisa Yoshinaga Shigetaka
|
|
Abstract
|
|
|
Endoscopic resection (ER) is widely performed for early gastric cancer (EGC) with a negligible risk of lymph node metastasis (LNM) in Eastern Asian countries. In particular, endoscopic submucosal dissection (ESD) leads to a high en bloc resection rate, enabling accurate pathological evaluation. As undifferentiated EGC (UD-EGC) is known to result in a higher incidence of LNM and infiltrative growth than differentiated EGC (D-EGC), the indications for ER are limited compared with those for D-EGC. Previously, clinical staging as intramucosal UD-EGC ¡Â2 cm, without ulceration, was presented as ¡®weakly recommended¡¯ or ¡®expanded indications¡¯ for ER in the guidelines of the United States, Europe, Korea, and Japan. Based on promising long-term outcomes from a prospective multicenter study by the Japan Clinical Oncology Group (JCOG) 1009/1010, the status of this indication has expanded and is now considered ¡®absolute indications¡¯ in the latest Japanese guidelines published in 2021. In this study, which comprised 275 patients with UD-EGC (cT1a, ¡Â2 cm, without ulceration) treated with ESD, the 5-year overall survival (OS) was 99.3% (95% confidence interval, 97.1%?99.8%), which was higher than the threshold 5-year OS (89.9%). Currently, the levels of evidence grades and recommendations for ER of UD-EGC differ among Japan, Korea, and Western countries. Therefore, a further discussion is warranted to generalize the indications for ER of UD-EGC in countries besides Japan.
|
|
KEYWORD
|
|
Gastric cancer, Stomach, Neoplasms, Endoscopy, Endoscopic submucosal dissection
|
|
FullTexts / Linksout information
|
|
|
|
Listed journal information
|
|
|
|