Skip to main content
SpringerLink
Log in

Endoscopic Resection for Undifferentiated-Type Early Gastric Cancer: Immediate Endoscopic Outcomes and Long-Term Survivals

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Endoscopic resection (ER) is considered carefully as a curative treatment option for selected cases of undifferentiated-type early gastric cancer (UEGC). This study investigated immediate endoscopic and long-term survival outcomes of patients with UEGC treated with ER.

Methods

A review of a database of 2483 EGC consecutively enrolled patients who underwent ER between January 2004 and December 2010 identified 101 patients with UEGC who met the expanded indications. Outcomes were investigated in these patients.

Results

The rates of R0 en bloc and curative resection were 86 and 70 %, respectively. Of 30 tumors non-curatively resected, 17 were larger than 20 mm in diameter, 12 had positive resection margins, and 13 had submucosal or lymphovascular invasion on resection pathology. ER-related complications occurred in 12 patients (12 %), with all complications treated endoscopically without surgery. The median ER procedure time was 26 min [interquartile range (IQR) 20–39 min]. Only tumor location in the lower part of the stomach was significantly associated with curative ER (P = 0.038). Tumor recurrence was observed in seven patients at a median 17 months (IQR 12–47 months) after ER. During a median follow-up of 60 months (IQR 48–80 months), the 5-year overall mortality rates were 5 % in the curative and 4 % in the non-curative resection groups (P = 0.927). There were no gastric cancer-related deaths.

Conclusions

ER shows acceptable immediate endoscopic and long-term survival outcomes in selected patients with UEGC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. Carter KJ, Schaffer HA, Ritchie WP. Early gastric cancer. Ann Surg. 1984;199:604–609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Rembacken BJ, Gotoda T, Fujii T, Axon AT. Endoscopic mucosal resection. Endoscopy. 2001;33:709–718.

    Article  CAS  PubMed  Google Scholar 

  3. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10:1–11.

    Article  PubMed  Google Scholar 

  4. Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol.. 2005;23:4490–4498.

    Article  PubMed  Google Scholar 

  5. Shimada Y, JGCA (The Japan Gastric Cancer Association). Gastric cancer treatment guidelines. Jpn J Clin Oncol. 2004;34:58.

    Article  CAS  PubMed  Google Scholar 

  6. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 2nd English edn. Gastric Cancer. 1998;1:10–24.

    Article  PubMed  Google Scholar 

  7. Yamao T, Shirao K, Ono H, et al. Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer. 1996;77:602–606.

    Article  CAS  PubMed  Google Scholar 

  8. Adachi Y, Mori M, Maehara Y, Kitano S, Sugimachi K. Prognostic factors of node-negative gastric carcinoma: univariate and multivariate analyses. J Am Coll Surg. 1997;184:373–377.

    CAS  PubMed  Google Scholar 

  9. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–225.

    Article  PubMed  Google Scholar 

  10. Japanese Gastric Cancer Association. Japanese gastric cancer-treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–123.

    Article  Google Scholar 

  11. Kwak CS, Lee HK, Cho SJ, et al. Analysis of clinicopathological factors associated with lymph node metastasis in early gastric cancer review of 2,137 cases. J Korean Cancer Assoc. 2000;32:674–681.

    Google Scholar 

  12. Yamaguchi N, Isomoto H, Fukuda E, et al. Clinical outcomes of endoscopic submucosal dissection for early gastric cancer by indication criteria. Digestion. 2009;80:173–181.

    Article  PubMed  Google Scholar 

  13. Oka S, Tanaka S, Kaneko I, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64:877–883.

    Article  PubMed  Google Scholar 

  14. Tanabe S, Ishido K, Higuchi K, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center. Gastric Cancer. 2014;17:130–136.

    Article  PubMed  Google Scholar 

  15. Ahn JY, Jung HY, Choi KD, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc. 2011;74:485–493.

    Article  PubMed  Google Scholar 

  16. Travis WD, Brambilla E, Muller-Hermelink HK. World Health Organization Classification of tumors. Lyon: IARC; 2000.

    Google Scholar 

  17. Hirasawa T, Gotoda T, Miyata S, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer. 2009;12:148–152.

    Article  PubMed  Google Scholar 

  18. Abe N, Watanabe T, Sugiyama M, et al. Endoscopic treatment or surgery for undifferentiated early gastric cancer? Am J Surg. 2004;188:181–184.

    Article  PubMed  Google Scholar 

  19. Li C, Kim S, Lai JF, et al. Risk factors for lymph node metastasis in undifferentiated early gastric cancer. Ann Surg Oncol. 2008;15:764–769.

    Article  PubMed  Google Scholar 

  20. Park YD, Chung YJ, Chung HY, et al. Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach. Endoscopy. 2008;40:7–10.

    Article  CAS  PubMed  Google Scholar 

  21. Kim JH, Lee YC, Kim H, et al. Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc. 2009;69:e1–e9.

    Article  PubMed  Google Scholar 

  22. Yamamoto Y, Fujisaki J, Hirasawa T, et al. Therapeutic outcomes of endoscopic submucosal dissection of undifferentiated-type intramucosal gastric cancer without ulceration and preoperatively diagnosed as 20 millimetres or less in diameter. Dig Endosc. 2010;22:112–118.

    Article  PubMed  Google Scholar 

  23. Okada K, Fujisaki J, Yoshida T, et al. Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy. 2012;44:122–127.

    Article  CAS  PubMed  Google Scholar 

  24. Abe S, Oda I, Suzuki H, et al. Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Endoscopy. 2013;45:703–707.

    Article  PubMed  Google Scholar 

  25. Kim YY, Jeon SW, Kim J, et al. Endoscopic submucosal dissection for early gastric cancer with undifferentiated histology: could we extend the criteria beyond? Surg Endosc. 2013;27:4656–4662.

    Article  PubMed  Google Scholar 

  26. Oka S, Tanaka S, Higashiyama M, et al. Clinical validity of the expanded criteria for endoscopic resection of undifferentiated-type early gastric cancer based on long-term outcomes. Surg Endosc. 2014;28:639–647.

    Article  PubMed  Google Scholar 

  27. Ninomiya Y, Yanagisawa A, Kato Y, Tomimatsu H. Unrecognizable intramucosal spread of diffuse-type mucosal gastric carcinomas of less than 20 mm in size. Endoscopy. 2000;32:604–608.

    Article  CAS  PubMed  Google Scholar 

  28. Sawada S, Fujisaki J, Yamamoto N, et al. Expansion of indications for endoscopic treatment of undifferentiated mucosal gastric cancer: analysis of intramucosal spread in resected specimens. Dig Dis Sci. 2010;55:1376–1380.

    Article  PubMed  Google Scholar 

  29. Hizawa K, Iwai K, Esaki M, Matsumoto T, Suekane H, Iida M. Is endoscopic ultrasonography indispensable in assessing the appropriateness of endoscopic resection for gastric cancer? Endoscopy. 2002;34:973–978.

    Article  CAS  PubMed  Google Scholar 

  30. Kim JH, Song KS, Youn YH, et al. Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer. Gastrointest Endosc. 2007;66:901–908.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

      Ji Yong Ahn, Hee Jung Park, Jeong Hoon Lee, Kwi-Sook Choi, Kee Wook Jeong, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee & Hwoon-Yong Jung

    2. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

      Young Soo Park

    Authors
    1. Ji Yong Ahn
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Hee Jung Park
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Young Soo Park
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Jeong Hoon Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Kwi-Sook Choi
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Kee Wook Jeong
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Do Hoon Kim
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Kee Don Choi
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Ho June Song
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Gin Hyug Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Hwoon-Yong Jung
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Ho June Song.

    Ethics declarations

    Conflict of interest

    The authors declare no conflict of interest.

    Additional information

    Ji Yong Ahn and Hee Jung Park have contributed equally to this work as co-first authors.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Ahn, J.Y., Park, H.J., Park, Y.S. et al. Endoscopic Resection for Undifferentiated-Type Early Gastric Cancer: Immediate Endoscopic Outcomes and Long-Term Survivals. Dig Dis Sci 61, 1158–1164 (2016). https://doi.org/10.1007/s10620-015-3988-y

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10620-015-3988-y

    Keywords

    Search

    Navigation