Clin Endosc.  2017 Nov;50(6):569-577. 10.5946/ce.2017.017.

Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis

Affiliations
  • 1Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea. baikgh@hallym.or.kr
  • 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 3Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
  • 6Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea.
  • 7Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
  • 8Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

Abstract

BACKGROUND/AIMS
To assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology.
METHODS
Cases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed.
RESULTS
From 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years).
CONCLUSIONS
ER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.

Keyword

Endoscopic mucosal resection; Stomach neoplasms; Undifferentiated
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