Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria

O. Goto, M. Fujishiro, S. Kodashima, S. Ono, M. Omata

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

Background and study aims: Endoscopic submucosal dissection (ESD) is a novel, promising endoscopic technique for gastrointestinal neoplasms. We aimed to elucidate the feasibility of ESD as curative treatment for intestinal-type early gastric cancer (EGC) potentially without lymph-node metastases. Patients and methods: For the short-term analysis, 276 consecutive, intestinal-type EGCs, which fulfilled the criteria for node-negative EGC in 231 patients who had undergone ESD from January 2000 to March 2007, were retrospectively investigated. For the long-term analysis, 212 lesions checked by endoscopy later than 1 year or recurrence within 1 year after ESD were assessed for local recurrence, and 208 patients followed for over 1 year or to death within 1 year after ESD were assessed for metastases and survival. All lesions/patients were divided into three groups: intramucosal cancer without ulcerative findings (M-Ul[-]); intramucosal cancer with ulcerative findings, ≤ 3 cm (M-Ul[+]); and slight invasive cancer into submucosa (< 500 μm), ≤ 3 cm (SM1). Results: En bloc and complete resection rates were 96.7% and 91.7 %, respectively. During a median follow-up of 36 months (range 2-93 months), two local recurrences occurred (0.9 %), which were detected at 2 and 6 months after ESD, respectively. During a median follow-up of 38 months (range 6-97 months), the 5-year overall and disease-specific survival rates were 96.2% and 100%, respectively, with neither lymph node nor other-organ metastasis; one patient died due to other disease 6 months after ESD. No disease-related death occurred. No significant differences were found between the groups in short- and long-term analyses. Conclusions: The prognostic analyses demonstrated the validity of the criteria of node-negative intestinal-type EGC as curability criteria for ESD. ESD can be proposed as an alternative method to gastrectomy for the treatment of these EGCs.

Original languageEnglish
Pages (from-to)118-122
Number of pages5
JournalEndoscopy
Volume41
Issue number2
DOIs
Publication statusPublished - 2009 Feb
Externally publishedYes

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Stomach Neoplasms
Neoplasm Metastasis
Recurrence
Lymph Nodes
Endoscopic Mucosal Resection
Neoplasms
Gastrointestinal Neoplasms
Gastrectomy
Endoscopy
Survival Rate
Survival
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

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Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. / Goto, O.; Fujishiro, M.; Kodashima, S.; Ono, S.; Omata, M.

In: Endoscopy, Vol. 41, No. 2, 02.2009, p. 118-122.

Research output: Contribution to journalArticle

Goto, O. ; Fujishiro, M. ; Kodashima, S. ; Ono, S. ; Omata, M. / Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. In: Endoscopy. 2009 ; Vol. 41, No. 2. pp. 118-122.
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AB - Background and study aims: Endoscopic submucosal dissection (ESD) is a novel, promising endoscopic technique for gastrointestinal neoplasms. We aimed to elucidate the feasibility of ESD as curative treatment for intestinal-type early gastric cancer (EGC) potentially without lymph-node metastases. Patients and methods: For the short-term analysis, 276 consecutive, intestinal-type EGCs, which fulfilled the criteria for node-negative EGC in 231 patients who had undergone ESD from January 2000 to March 2007, were retrospectively investigated. For the long-term analysis, 212 lesions checked by endoscopy later than 1 year or recurrence within 1 year after ESD were assessed for local recurrence, and 208 patients followed for over 1 year or to death within 1 year after ESD were assessed for metastases and survival. All lesions/patients were divided into three groups: intramucosal cancer without ulcerative findings (M-Ul[-]); intramucosal cancer with ulcerative findings, ≤ 3 cm (M-Ul[+]); and slight invasive cancer into submucosa (< 500 μm), ≤ 3 cm (SM1). Results: En bloc and complete resection rates were 96.7% and 91.7 %, respectively. During a median follow-up of 36 months (range 2-93 months), two local recurrences occurred (0.9 %), which were detected at 2 and 6 months after ESD, respectively. During a median follow-up of 38 months (range 6-97 months), the 5-year overall and disease-specific survival rates were 96.2% and 100%, respectively, with neither lymph node nor other-organ metastasis; one patient died due to other disease 6 months after ESD. No disease-related death occurred. No significant differences were found between the groups in short- and long-term analyses. Conclusions: The prognostic analyses demonstrated the validity of the criteria of node-negative intestinal-type EGC as curability criteria for ESD. ESD can be proposed as an alternative method to gastrectomy for the treatment of these EGCs.

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