Korean J Gastroenterol.  2013 Apr;61(4):196-202. 10.4166/kjg.2013.61.4.196.

Therapeutic Outcomes of Endoscopic Submucosal Dissection in Undifferentiated-type Early Gastric Cancer

• Choi MH
• Hong SJ
• Han JP
• Song JY
• Kim DY
• Seo SW
• Ha JS
• Lee YN
• Ko BM
• Lee MS

• KMID: 1775758
• DOI: http://doi.org/10.4166/kjg.2013.61.4.196

Abstract

BACKGROUND/AIMS
Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment of early gastric cancer (EGC). However, the indication of ESD in undifferentiated-type EGC was controversial. The aim of this study was to evaluate the therapeutic outcomes of ESD in undifferentiated-type EGC according to expanded indication.
METHODS
At Soonchunhyang University Bucheon Hospital, a total of 82 lesions in 81 patients with undifferentiated-type EGC were treated with ESD. The therapeutic outcomes of ESD were evaluated by resection method (en bloc resection; piecemeal resection), histologic curative resection, complications and recurrence rates after ESD.
RESULTS
The rate on en bloc resection and complete resection rate were 87.8% (72/82) and 80.5% (66/82), respectively. In signet ring cell carcinoma, the complete resection rate was higher than those in poorly differentiated adenocarcinoma and poorly differentiated adenocarcinoma with signet ring cell features, but there was no statistical significance (89.3% vs. 75.0%, 76.7%; p=0.347). The lateral margin positivity rate in poorly differentiated adenocarcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma with signet ring cell features were 12.5%, 3.6% and 13.3%, respectively (p=0.395). The vertical margin positivity rate were 12.5%, 3.6% and 10.0%, respectively (p=0.485). The overall recurrence rate was 3.0% during a mean follow-up period of 37.4 months.
CONCLUSIONS
ESD may be considered as a feasible treatment for undifferentiated-type EGC according to expanded indication. The therapeutic outcome of ESD in undifferentiated-type EGC is likely to be favorable, though further longer follow-up studies are needed.

Keyword

Undifferentiated carcinoma; Early gastric cancer; Endoscopic submucosal dissection; Complete resection

MeSH Terms

Adenocarcinoma/pathology/*surgery/ultrasonography
Adult
Aged
Carcinoma, Signet Ring Cell/pathology/*surgery/ultrasonography
Early Detection of Cancer
Female
Follow-Up Studies
Gastroscopy
Humans
Male
Middle Aged
Recurrence
Retrospective Studies
Stomach Neoplasms/pathology/*surgery/ultrasonography
Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1. Clinical courses after ESD in undifferentiated EGC. ESD, endoscopic submucosal dissection; EGC, early gastric cancer; CR, complete resection; ICR, incomplete resection; LVI, lymphovascular invasion; LMI, lateral margin invasion; VMI, vertical margin invasion; OP, operation; APC, argon plasma coagulation; F/U, fo-llow-up; Recur, recurrence.

Reference

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