Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer

K. Okada; J. Fujisaki; T. Yoshida; H. Ishikawa; T. Suganuma; A. Kasuga; M. Omae; M. Kubota; A. Ishiyama; T. Hirasawa; A. Chino; M. Inamori; Y. Yamamoto; N. Yamamoto; T. Tsuchida; Y. Tamegai; A. Nakajima; E. Hoshino; M. Igarashi

doi:10.1055/s-0031-1291486

Endoscopy, Table of Contents

Endoscopy 2012; 44(02): 122-127
DOI: 10.1055/s-0031-1291486

Original article

Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer

K. Okada

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

²Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan

,

J. Fujisaki

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

T. Yoshida

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

H. Ishikawa

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

T. Suganuma

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

A. Kasuga

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

M. Omae

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

M. Kubota

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

A. Ishiyama

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

T. Hirasawa

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

A. Chino

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

M. Inamori

²Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan

,

Y. Yamamoto

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

N. Yamamoto

³Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

T. Tsuchida

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

Y. Tamegai

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

A. Nakajima

²Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan

,

E. Hoshino

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

,

M. Igarashi

¹Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

› Author Affiliations

Abstract

Background and study aim: Endoscopic submucosal dissection (ESD) of undifferentiated-type early gastric cancer (UD-EGC) is technically feasible; however, the long-term clinical outcomes of the procedure have not yet been fully investigated. The aim of our study was to elucidate long-term outcomes of ESD for UD-EGC.

Patients and methods: Between September 2003 and October 2009, a total of 153 patients were diagnosed endoscopically as having UD-EGC fulfilling the expanded criteria for ESD. After informed consent was obtained, 101 patients were selected to undergo ESD and 52 to undergo surgical operation. We assessed the clinical outcomes of ESD in 101 consecutive patients with 103 UD-EGC lesions who were undergoing ESD for the first time. The overall mortality and disease-free survival rates after ESD were evaluated as the long-term outcomes.

Results: The rates of en bloc and curative resection were 99.0 % (102 /103) and 82.5 % (85 /103), respectively. We encountered one patient with nodal metastasis detected by computed tomography before diagnostic ESD, although curative resection of the primary lesion was achieved based on routine histological examination. Among the 78 patients without a past history of malignancy within the previous 5 years in whom curative resection of the primary lesion was achieved, no cases of local recurrence or distant metastasis were observed during follow-up; however, 1 synchronous and 2 metachronous lesions were detected in 2 patients (2.6 %) after primary ESD. Thus, estimated over a median follow-up period of 40.0 months (range 19 – 92 months) and 36.0 months (range 9 – 92 months), the 3 – and 5-year overall mortality rates were 1.9 % and 3.9 %, respectively, and the 3 – and 5-year overall disease-free survival rates were both 96.7 %.

Conclusions: Although our single-center retrospective study may be considered to be only preliminary, our data indicate that ESD for UD-EGC may yield good long-term outcomes.

Full Text

References

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