J Gastric Cancer.  2023 Jan;23(1):146-158. 10.5230/jgc.2023.23.e13.

Endoscopic Resection of Undifferentiated Early Gastric Cancer

• Hirai Y
• Abe S
• Makiguchi ME
• Sekiguchi M
• Nonaka S
• Suzuki H
• Yoshinaga S
• Saito Y

• KMID: 2539478
• DOI: http://doi.org/10.5230/jgc.2023.23.e13

Abstract

Endoscopic resection (ER) is widely performed for early gastric cancer (EGC) with a negligible risk of lymph node metastasis (LNM) in Eastern Asian countries. In particular, endoscopic submucosal dissection (ESD) leads to a high en bloc resection rate, enabling accurate pathological evaluation. As undifferentiated EGC (UD-EGC) is known to result in a higher incidence of LNM and infiltrative growth than differentiated EGC (D-EGC), the indications for ER are limited compared with those for D-EGC. Previously, clinical staging as intramucosal UD-EGC ≤2 cm, without ulceration, was presented as ‘weakly recommended’ or ‘expanded indications’ for ER in the guidelines of the United States, Europe, Korea, and Japan. Based on promising long-term outcomes from a prospective multicenter study by the Japan Clinical Oncology Group (JCOG) 1009/1010, the status of this indication has expanded and is now considered ‘absolute indications’ in the latest Japanese guidelines published in 2021. In this study, which comprised 275 patients with UD-EGC (cT1a, ≤2 cm, without ulceration) treated with ESD, the 5-year overall survival (OS) was 99.3% (95% confidence interval, 97.1%–99.8%), which was higher than the threshold 5-year OS (89.9%). Currently, the levels of evidence grades and recommendations for ER of UD-EGC differ among Japan, Korea, and Western countries. Therefore, a further discussion is warranted to generalize the indications for ER of UD-EGC in countries besides Japan.

Keyword

Gastric cancer; Stomach; Neoplasms; Endoscopy; Endoscopic submucosal dissection