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A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer

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Abstract

Background

Endoscopic submucosal dissection (ESD) is the standard treatment for selected cases of early gastric cancer (EGC). Evolution of ESD techniques and accessories has expanded treatment indications. The aim of this study was to compare the therapeutic outcomes for conventional and expanded indications of ESD for EGC.

Methods

Eight hundred six EGC lesions in 780 patients were classified into two groups based on a pathological review: a conventional indication group (595 cases) and an expanded indication group (211 cases). The expanded indication group was classified further into subgroups according to tumor depth and tumor size. Therapeutic outcomes were compared between the conventional and expanded indication groups and between the expanded indication subgroups.

Results

The complete resection rate (97.3% vs. 81.0%, p < 0.001) and en bloc complete resection rate (95.6% vs. 79.1%, p = 0.003) were higher in the conventional indication group than in the expanded indication group. Among the expanded indication patients, the complete resection rate (64.5% vs. 91.1%, p < 0.001) and en bloc complete resection rate (63.2% vs. 89.6%, p < 0.001) were lower in the submucosal invasion subgroup than in the mucosal invasion subgroup. The complete resection rate and en bloc complete resection rate did not differ between subgroups classified according to tumor size in the expanded indication group. The conventional indication group and expanded indication group did not differ with regard to the rates of local recurrence (0.7% vs. 0%), metachronous recurrence (3.6% vs. 3.3%), or cumulative disease-free survival. Survival outcome was similar in the subgroups classified by tumor depth and size. Perforation was more frequent in the expanded indication group than in the conventional indication group (6.6% vs. 2.4%, p < 0.001).

Conclusion

ESD for expanded indication of EGC had acceptable clinical outcomes. ESD can be applied safely to properly selected patients with EGC.

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Abbreviations

EGC:

Early gastric cancer

AGC:

Advanced gastric cancer

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Disclosures

Hyuk Lee, Won Kyoung,Yun, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Kyoung Mee Kim, Jong Chul Rhee, and Jae J. Kim have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

    Hyuk Lee

  2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Won Kyoung Yun, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jong Chul Rhee & Jae J. Kim

  3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Kyoung Mee Kim

  4. Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-Gu, Seoul, Korea

    Jae J. Kim

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  1. Hyuk Lee
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Corresponding author

Correspondence to Jae J. Kim.

Additional information

H. Lee and W. K. Yun contributed equally to this work.

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Lee, H., Yun, W.K., Min, BH. et al. A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 25, 1985–1993 (2011). https://doi.org/10.1007/s00464-010-1499-7

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  • DOI: https://doi.org/10.1007/s00464-010-1499-7

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