Gut Liver.  2018 May;12(3):263-270. 10.5009/gnl17247.

Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort

• Kwak DS
• Min YW
• Lee JH
• Kang SH
• Jang SH
• Lee H
• Min BH
• Kim JJ
• Kim KM
• Sohn TS
• Kim S

• KMID: 2411671
• DOI: http://doi.org/10.5009/gnl17247

Abstract

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.

Keyword

Early gastric cancer; Endoscopic mucosal resection; Undifferentiated

MeSH Terms

Adenocarcinoma
Biopsy
Carcinoma, Signet Ring Cell
Cohort Studies*
Gastrectomy
Humans
Lymph Nodes
Neoplasm Metastasis
Stomach Neoplasms*