Gut Liver.
2016 Sep;10(5):739-748. 10.5009/gnl15466.
Short-Term Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study
- Affiliations
-
- 1Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
- 2National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea. seolsymd@hanmail.net
- 3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
- 4Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
- 5Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
- 6Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 7College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea.
- 8Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
- 9Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
- 10Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea.
- 11Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
- 12Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
- 13Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 14Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 15Department of Internal Medicine, Institute of Digestive Diseases and Nutrition, Korea University College of Medicine, Seoul, Korea. drchunhj@chol.com
- KMID: 2412071
- DOI: http://doi.org/10.5009/gnl15466
Abstract
- BACKGROUND/AIMS
Endoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC) that has demonstrated a minimal risk of lymph node metastasis in retrospective studies. We sought to prospectively evaluate the short-term outcomes of ESD treatment in EGCs.
METHODS
A prospective multicenter cohort study of neoplasms 3 cm or less in diameter at endoscopic size evaluation was performed in 12 Korean ESD study group-related university hospitals and the National Cancer Center. Resected specimens were evaluated by the central pathologic review board.
RESULTS
A patient cohort (n=712) with a total of 737 EGCs was analyzed. The margin-freeen bloc resection rate was 97.3%, and curative resection of 640 lesions (86.8%) was achieved. Lower curative resection rates were associated with lesions 2 to 3 cm in size prior to ESD compared with lesions 2 cm or less in size (78.6% vs 88.1%, respectively, p=0.009). Significant factors associated with noncurative resection were moderately or poorly differentiated histological type, posterior wall tumor location, tumor size larger than 3 cm, ulceration, and submucosal invasion. Delayed bleeding occurred in 49 patients (6.9%), and 12 patients (1.7%) exhibited perforations.
CONCLUSIONS
ESD is an effective treatment with a high curative resection rate for EGCs that meets relatively conservative pre-ESD indications. Long-term survival outcomes should be evaluated in follow-up studies.
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