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Endoscopic submucosal dissection for early gastric cancer with undifferentiated histology: could we extend the criteria beyond?

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Abstract

Background

Endoscopic submucosal desection (ESD) is an effective treatment for selected patients with early gastric cancer (EGC). The purpose of this study was to examine the short-term and long-term outcomes of ESD of undifferentiated early gastric cancer.

Methods

Data for 1,241 patients who underwent ESD for treatment of EGC between February 2003 and May 2010 were collected. We performed a retrospective analysis of the medical records of 74 patients diagnosed with undifferentiated EGC. We divided the enrolled cases into two groups: the expanded-criteria group (EC group) versus the non-EC group, according to lesion size, presence of ulceration, and pathologic review.

Results

Of a total of 74 lesions with undifferentiated EGC, as a result of pathologic examination the EC group included 29 cases and the non-EC group included 45 cases. The mean diameter of lesions was 19.86 ± 12.5 mm. The overall rates of en bloc resection and complete resection were 90.5 % (67/74) and 73 % (54/74), respectively. The curative resection rate was low at 31.1 %. If limited to the pathologically diagnosed EC group, the curative resection rate was 79.3 % (23/29). During median follow-up periods of 34 months (range 7–81), local recurrences were observed in 5.5 % (4/74) of patients. All of these were in the non-EC group and all underwent noncurative resection. There was no mortality related to ESD for treatment of EGC during follow-up.

Conclusions

ESD may be a feasible treatment for selected patients with undifferentiated EGC; this should be validated by development of new criteria for ESD for treatment of EGC.

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Disclosures

Drs. Yi Young Kim, Seong Woo Jeon, JiYeon Kim, Jung Chul Park, Kwang Bum Cho, Kyung Sik Park, Eun Soo Kim, Yun Jin Chung, Joong Goo Kwon, Jin Tae Jung, Eun Young Kim, Kyeong Ok Kim, ByungIk Jang, Si Hyung Lee, Chang Hun Yang have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 50, Samduk 2-Ga, Chung-gu, Daegu, 700-721, South Korea

    Yi Young Kim, Seong Woo Jeon, JiYeon Kim & Jung Chul Park

  2. Department of Internal Medicine, Keimyung University College of Medicine, Daegu, South Korea

    Kwang Bum Cho, Kyung Sik Park & EunSoo Kim

  3. Department of Internal Medicine, Fatima Hospital, Daegu, South Korea

    Yun Jin Chung

  4. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea

    Joong Goo Kwon, Jin Tae Jung & Eun Young Kim

  5. Department of Internal Medicine, Yeungnam University School of Medicine, Daegu, South Korea

    Kyeong Ok Kim, ByungIk Jang & Si Hyung Lee

  6. Department of Internal Medicine, Dongguk University School of Medicine, Kyungju, South Korea

    Chang Hun Yang

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  1. Yi Young Kim
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  2. Seong Woo Jeon
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  13. ByungIk Jang
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  14. Si Hyung Lee
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  15. Chang Hun Yang
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Corresponding author

Correspondence to Seong Woo Jeon.

Additional information

All authors are members of Daegu-Gyeongbuk Gastrointestinal Study Group (DGSG), Daegu, South Korea.

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Kim, Y.Y., Jeon, S.W., Kim, J. et al. Endoscopic submucosal dissection for early gastric cancer with undifferentiated histology: could we extend the criteria beyond?. Surg Endosc 27, 4656–4662 (2013). https://doi.org/10.1007/s00464-013-3099-9

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  • DOI: https://doi.org/10.1007/s00464-013-3099-9

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