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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2011

01-06-2011

A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer

Authors: Hyuk Lee, Won Kyoung Yun, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Kyoung Mee Kim, Jong Chul Rhee, Jae J. Kim

Published in: Surgical Endoscopy | Issue 6/2011

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Abstract

Background

Endoscopic submucosal dissection (ESD) is the standard treatment for selected cases of early gastric cancer (EGC). Evolution of ESD techniques and accessories has expanded treatment indications. The aim of this study was to compare the therapeutic outcomes for conventional and expanded indications of ESD for EGC.

Methods

Eight hundred six EGC lesions in 780 patients were classified into two groups based on a pathological review: a conventional indication group (595 cases) and an expanded indication group (211 cases). The expanded indication group was classified further into subgroups according to tumor depth and tumor size. Therapeutic outcomes were compared between the conventional and expanded indication groups and between the expanded indication subgroups.

Results

The complete resection rate (97.3% vs. 81.0%, p < 0.001) and en bloc complete resection rate (95.6% vs. 79.1%, p = 0.003) were higher in the conventional indication group than in the expanded indication group. Among the expanded indication patients, the complete resection rate (64.5% vs. 91.1%, p < 0.001) and en bloc complete resection rate (63.2% vs. 89.6%, p < 0.001) were lower in the submucosal invasion subgroup than in the mucosal invasion subgroup. The complete resection rate and en bloc complete resection rate did not differ between subgroups classified according to tumor size in the expanded indication group. The conventional indication group and expanded indication group did not differ with regard to the rates of local recurrence (0.7% vs. 0%), metachronous recurrence (3.6% vs. 3.3%), or cumulative disease-free survival. Survival outcome was similar in the subgroups classified by tumor depth and size. Perforation was more frequent in the expanded indication group than in the conventional indication group (6.6% vs. 2.4%, p < 0.001).

Conclusion

ESD for expanded indication of EGC had acceptable clinical outcomes. ESD can be applied safely to properly selected patients with EGC.
Literature
1.
Korea National Statistical Office (2006) Annual Report on the Cause of Death Statistics
2.
Jeong HY (2008) Limitations of EMR/ESD expanded indication in early gastric cancer. J Korean Gastric Cancer Assoc 8:5–8
3.
4.
5.
6.
Soetikno R, Kaltenbach T, Yeh R, Gotoda T (2005) Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 23:4490–4498PubMedCrossRef
7.
Gotoda T (2005) A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 3:S71–S73PubMedCrossRef
8.
Takekoshi T, Baba Y, Ota H, Kato Y, Yanagisawa A, Takagi K, Noguchi Y (1994) Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases. Endoscopy 26:352–358PubMedCrossRef
9.
Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225PubMedCrossRef
10.
11.
Maruyama K, Okabayashi K, Kinoshita T (1987) Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 11:418–425PubMedCrossRef
12.
Sano T, Sasako M, Kinoshita T, Maruyama K (1993) Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature. Cancer 72:3174–3178PubMedCrossRef
13.
Yamazaki H, Oshima A, Murakami R, Endoh S, Ubukata T (1989) A long-term follow-up study of patients with gastric cancer detected by mass screening. Cancer 63:613–617PubMedCrossRef
14.
Ludwig K, Klautke G, Bernhard J, Weiner R (2005) Minimally invasive and local treatment for mucosal early gastric cancer. Surg Endosc 19:1362–1366PubMedCrossRef
15.
Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW et al (1995) Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748PubMedCrossRef
16.
Sasako M (1997) Risk factors for surgical treatment in the Dutch Gastric Cancer Trial. Br J Surg 84:1567–1571PubMedCrossRef
17.
Sasako M, Kinoshita T, Maruyama K (1993) Prognosis of early gastric cancer. Stomach and Intestine 28:139–146 (in Japanese; abstract in English)
18.
Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883PubMedCrossRef
19.
Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229PubMedCrossRef
20.
Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T, Doi T, Otani Y, Fujisaki J, Ajioka Y, Hamada T, Inoue H, Gotoda T, Yoshida S (2006) A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 9:262–270PubMedCrossRef
21.
Gotoda T, Yamamoto H, Soetikno RM (2006) Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 41:929–942PubMedCrossRef
22.
Lee JH, Kim JJ (2007) Endoscopic mucosal resection of early gastric cancer: Experiences in Korea. World J Gastroenterol 13:3657–3661PubMedCrossRef
23.
Hyun DH, Jeong S, Lee JW, Jeong BJ, Ryu ST, Lee CK, Kim MS, Kwon KS, Lee DH, Kim PS, Kim HG, Shin YW, Kim YS (2003) Usefulness of endoscopic mucosal resection for curative treatment of early gastric cancer. Korean J Gastroenterol 42:453–460PubMed
24.
Akiko T, Tsuneo O, Yoshinori M, Akihisa T, Kinichi H, Syuko M, Masaki T, Shinichi F (2006) The possibility of ESD expansion in early gastric cancer. Stomach Intestine 41:1133–1140
25.
Sano T, Kobori O, Muto T (1992) Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 79:241–244PubMedCrossRef
26.
Abe N, Mori T, Izumisato Y, Sasaki H, Ueki H, Masaki T, Nakashima M, Sugiyama M, Atomi Y (2003) Successful treatment of an undifferentiated early stage gastric cancer by combined en bloc EMR and laparoscopic regional lymphadenectomy. Gastrointest Endosc 57:972–975PubMedCrossRef
27.
Abe N, Mori T, Takeuchi H, Yoshida T, Ohki A, Ueki H, Yanagida O, Masaki T, Sugiyama M, Atomi Y (2005) Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer. Am J Surg 190:496–503PubMedCrossRef
28.
Park DJ, Lee HK, Lee HJ, Lee HS, Kim WH, Yang HK, Lee KU, Choe KJ (2004) Lymph node metastasis in early gastric cancer with submucosal invasion: feasibility of minimally invasive surgery. World J Gastroenterol 10:3549–3552PubMed
29.
Schlemper RJ, Kato Y, Stolte M (2000) Diagnostic criteria for gastrointestinal carcinomas in Japan and Western countries: proposal for a new classification system of gastrointestinal epithelial neoplasia. J Gastroenterol Hepatol 15:G49–G57PubMedCrossRef
30.
Cai J, Ikeguchi M, Maeta M, Kaibara N (2000) Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer. Surgery 127:32–39PubMedCrossRef
31.
Cai J, Ikeguchi M, Tsujitani S, Maeta M, Kaibara N (2000) Micrometastasis in lymph nodes of mucosal gastric cancer. Gastric Cancer 3:91–96PubMedCrossRef
Metadata
Title
A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer
Authors
Hyuk Lee
Won Kyoung Yun
Byung-Hoon Min
Jun Haeng Lee
Poong-Lyul Rhee
Kyoung Mee Kim
Jong Chul Rhee
Jae J. Kim
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 6/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1499-7

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