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Endoscopic submucosal dissection for undifferentiated-type early gastric cancer: short- and long-term outcomes

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Abstract

Background and aims

Application of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancers (EGCs) remains controversial owing to limited data regarding long-term outcomes. We aimed to evaluate the feasibility of ESD for undifferentiated-type EGCs that meet the expanded criteria (EC).

Methods

We performed a retrospective analysis of 66 patients who underwent ESD for undifferentiated-type EGC between January 2005 and December 2014. We evaluated the rates of en bloc, complete, and curative resections along with overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS).

Results

Of the 66 patients, the EC group included 38 patients and the beyond-EC group included 28 patients. The overall rates of en bloc, complete, and curative resection of the 66 lesions were 92.4% (61/66), 65.2% (43/66), and 48.5% (32/66), respectively. Of the 34 patients with non-curative resection, 18 underwent additional surgery. Local remnant cancer was detected in 1 patient (1/18, 5.6%), and none of the 18 patients had lymph node metastasis. On multivariate analysis, tumors > 2 cm [odd ratio (OR) 6.183, 95% confidence interval (CI) 1.279–29.880, p = 0.023) and submucosal invasion depth (OR 6.226, 95% CI 1.881–20.606, p = 0.003) were independent predictors of incomplete resection. All 26 patients with more than 1 year of follow-up after curative resection survived without any evidence of local or distant recurrences over a median follow-up period of 36 months. The OS, DSS, and RFS rates of patients with curative ESD were 93.8, 100, and 100%, respectively.

Conclusions

ESD may have favorable long-term outcomes in patients with undifferentiated-type EGC after curative resection.

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Acknowledgements

This study was supported by a Grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI12C1845).

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Author notes

  1. Hye Kyung Jeon and Seong Jun Lee are co-first authors for this article.

Authors and Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Republic of Korea

    Hye Kyung Jeon, Gwang Ha Kim, Bong Eun Lee & Geun Am Song

  2. Department of Internal Medicine, Joeun Gumgang Hospital, 1814-37 Gimhae-daero, Gimhae-si, Gyeongsangnam-do, Republic of Korea

    Seong Jun Lee

  3. Department of Pathology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Republic of Korea

    Do Youn Park

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  1. Hye Kyung Jeon
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  2. Seong Jun Lee
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Correspondence to Gwang Ha Kim.

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Disclosures

Hye Kyung Jeon, Seong Jun Lee, Gwang Ha Kim, Do Youn Park, Bong Eun Lee, and Geun Am Song have no conflict of interest or financial ties to disclose.

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Jeon, H.K., Lee, S.J., Kim, G.H. et al. Endoscopic submucosal dissection for undifferentiated-type early gastric cancer: short- and long-term outcomes. Surg Endosc 32, 1963–1970 (2018). https://doi.org/10.1007/s00464-017-5892-3

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  • DOI: https://doi.org/10.1007/s00464-017-5892-3

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