Korean J Gastroenterol.  2014 Feb;63(2):90-98. 10.4166/kjg.2014.63.2.90.

Comparison on the Long Term Outcome between Endoscopic Submucosal Dissection and Surgical Treatment for Undifferentiated Early Gastric Cancer

• Chung MW
• Jeong O
• Park YK
• Lee KH
• Lee JH
• Lee WS
• Joo YE
• Choi SK
• Cho SB

• KMID: 1730915
• DOI: http://doi.org/10.4166/kjg.2014.63.2.90

Abstract

BACKGROUND/AIMS
There are controversies on the efficacy and safety of endoscopic submucosal dissection (ESD) for undifferentiated early gastric cancer (EGC) despite the expansion of ESD indications. The aim of this study was to evaluate the long term outcome of ESD compared to that of surgical treatment in patients with undifferentiated EGC.
METHODS
A total of 76 patients who underwent ESD for undifferentiated EGC and 149 patients who met the ESD indication and received surgical treatment from January 2005 to December 2010 at Chonnam National University Hwasun Hospital were included.
RESULTS
In the ESD group, en bloc resection and complete resection were achieved in 84.2% (64/76) and 76.3% (58/76) of patients, respectively. Among these patients, 58 (76.3%) met the ESD indication (indication group), and the remaining 18 (23.7%) did not meet the ESD indication (above indication group). Complete resection rates for indication group and above indication group were 86.2% (50/58) and 44.4% (8/18), respectively (p<0.05). The mean follow-up period was 42.2+/-19.2 months. Total recurrence rates in the ESD group and operation group were 14.1% (9/76) and 0.7% (1/149), respectively (p<0.05). The main complication of ESD was bleeding (5.2%, 4/76). In the operation group, 2 (1.3%) patients died from postoperative bleeding and leakage of anastomosis site.
CONCLUSIONS
ESD may be a feasible and safe treatment modality compared to that of surgical treatment for undifferentiated EGC when managed according to the expanded criteria. However, close endoscopic surveillance is required in this group because of higher incidence of intragastric recurrence.

Keyword

Endoscopic submucosal dissection; Undifferentiated carcinoma; Early gastric cancer; Gastrectomy

MeSH Terms

Adult
Aged
Female
Follow-Up Studies
Gastric Mucosa/pathology/*surgery
Gastrointestinal Hemorrhage/etiology
Gastroscopy
Humans
Lymphatic Metastasis/pathology
Male
Middle Aged
Neoplasm Staging
Postoperative Complications
Recurrence
Retrospective Studies
Stomach Neoplasms/pathology/*surgery
Treatment Outcome

Figure

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  Fig. 1. Flow chart of patient inclusion. LN, lymph node; ESD, endoscopic submucosal dissection.

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  Fig. 2. Clinical courses after the endoscopic submucosal dissection (ESD) for undifferentiated early gastric cancer. APC, argon plasma coagulation; Tx, treatment; Op, operation.

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  Fig. 3. Kaplan-Meier curve of recurrence rates in patients with undifferentiated early gastric cancer after endoscopic submucosal dissection (ESD) or gastrectomy.

Reference

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