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KMID : 1188320180120030263
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Gut and Liver
2018 Volume.12 No. 3 p.263 ~ p.270
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Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort
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Kwak Dong-Shin
Min Yang-Won
Lee Jun-Haeng
Kang Soo-Hoon
Jang Seung-Hyeon
Lee Hyuk
Min Byung-Hoon
Kim Jae-J.
Kim Kyoung-Mee
Sohn Tae-Sung
Kim Sung
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Abstract
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Background/Aims: Outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC) need to be further evaluated. We aimed to simulate the outcomes of ESD for undifferentiated-type EGC from a surgical database.
Methods: Among 802 patients who underwent gastrectomy with endoscopic biopsy for poorly differentiated adenocarcinoma (PD-type) or signet ring cell carcinoma (SRC-type), ESD candidates meeting the expanded indication (n=280) were selected by reviewing the endoscopic images. According to the surgical pathologic results, the outcomes of the ESD simulation were evaluated.
Results: Among the candidates, 104 (37.1%) were PD-type and 176 (62.9%) were SRC-type. The curative resection (CR) rate was 42.1%. Among the patients with CR, three patients (2.5%) showed lymph node metastasis (LNM). Three EGCs with CR and LNM were mucosal cancers ≥1.0 cm in size. The CR rate was higher in the SRC-type than in the PD-type (48.3% vs 31.7%, respectively, p=0.007). In the SRC-type, the CR rate was increased, with a smaller size criterion for the ESD indication, but was similar between the 1.0 cm and 0.6 cm criteria (63.3% and 63.6%, respectively), whereas the CR rate was below 50% in all of the different tumor size criteria (2.0 to 0.6 cm) in the PD-type.
Conclusions: In undifferentiated-type EGC, ESD should be considered in selected patients with tumor sizes ＜1 cm and SRC histology.
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KEYWORD
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Early gastric cancer, Endoscopic mucosal resection, Undifferentiated
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