Therapeutic outcomes of endoscopic submucosal dissection (ESD) for patients with early gastric cancer and discrepancies in clinicopathologic pre and post ESD: A single center study in Mongolia

Aims Endoscopic submucosal Dissection (ESD) has emerged as a potent modality for treating Early Gastric Cancer(EGC). Despite its efficacy, patients diagnosed with early-stage gastric cancer may require additional surgical intervention based on both pre and post laparoscopic resection pathological diagnoses. The primary objective of this research is to refine the criteria for early gastric resection.

Methods From January 2022 to August 2024, a total of 166 cases of early gastric cancer underwent treatment via ESD. Lesions were classified based on pathological results using both absolute criteria (AC) and expanded criteria (EC). Subsequently, a retrospective analysis was conducted to assess and compare the therapeutic outcomes between the two categorized groups.

Results In the study, 166 cases aged 40-95 were analyzed, with 66.3% being male and 33.7% female. The average age for male participants was 62±11, and for females, it was 61±12. ESD was performed in 86.7% of cases with extreme indications and 13.2% with extended indications. Among cases with polar indications, 40.2% were depressed and non-ulcerated, 11.1% were depressed, and 33.3% were elevated and non-ulceration, 4.16% had elevated with ulceration, and 11.1% had flat with ulceration.For cases with extended indications, 54.5% were elevated and non-ulcerated, 9% were elevated and ulcerated, and 36.3% were depressed and non-ulcerated.Tissue analysis before Endoscopic Submucosal Dissection (ESD) surgery revealed the following distribution : 27.7% well-differentiated (WD), 12% moderately differentiated (MD), 20.4% low-grade, 15.6% high-grade, 15.6% hyperplastic polyp, and 8.4% mixed-type carcinoma. Post-ESD surgery, tissue analysis indicated: 41% WD, 8.4% MD, 6% low-grade, 15.6% high-grade, 13.2% hyperplastic polyp, 7.2% poorly differentiated (PD), and 1.2% undifferentiated carcinoma. Among all operated cases, tumors diagnosed with ulceration and tumors>3 cm in size were deeper into the muscle layer compared to non-ulceration tumors (p<0.005).According to post-ESD surgery tissue analysis (166/10), 6.0% of patients had submucosal invasion, and 3.6% had lymphovascular invasion. The discrepancy rate was 9.6% (166/16), with the most common cause of discrepancy between the pathology report pre-ESD and tumor size.

Conclusions The findings derived from preoperative endoscopy and histological analysis present inconsistencies when compared to those observed in postoperative histological analysis. With an overall discrepancy rate of 9.6%, careful evaluation of the depth of invasion is essential to reduce this rate. This is particularly crucial due to its correlation with other endoscopic findings, the pre-ESD pathology report, and the importance of optimal tissue extraction in practice.

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Artikel online veröffentlicht:
27. März 2025