Comparison between endoscopic submucosal resection and surgery for the curative resection of undifferentiated-type early
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ORIGINAL ARTICLE
Comparison between endoscopic submucosal resection and surgery for the curative resection of undifferentiated‑type early gastric cancer within expanded indications: a nationwide multi‑center study Ji Yong Ahn1 · Young‑II Kim2 · Woon Geon Shin3,20 · Hyo‑Joon Yang4 · Su Youn Nam5 · Byung‑Hoon Min6 · Jae‑Young Jang7 · Joo Hyun Lim8 · Jie ‑Hyun Kim9 · Wan Sik Lee10 · Bong Eun Lee11 · Moon Kyung Joo12 · Jae Myung Park13 · Hang Lak Lee14 · Tae‑ Geun Gweon15 · Moo In Park16 · Jeongmin Choi17 · Chung Hyun Tae18 · Young‑Woo Kim2 · Boram Park19 · II Ju Choi2 Received: 16 July 2020 / Accepted: 31 October 2020 © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2020
Abstract Background and aims Endoscopic submucosal dissection (ESD) for undifferentiated early gastric cancer (UD EGC) has debate due to the risk of lymph node metastasis. We investigated the outcomes of ESD compared to those of surgery for the UD EGC within expanded indication. Methods We reviewed 971 UD EGC patients performed ESD across 18 hospitals in Korea and 1812 patients who underwent surgical resection in two hospitals between February 2005 and May 2015. Of these cases, we enrolled a curative resected ESD group of 328 patients and surgery group of 383 cases within an expanded indication. Overall outcomes and one-toone propensity score-matched (218 ESD group vs 218 surgery group cases) outcomes for these two groups were analyzed. Results Over the 75.6 month median follow-up period for the 711 enrolled cases, recurrences occurred in 22 patients (6.7%) in the ESD group but not in the surgery group. Overall survival (OS) was higher in the surgery group (p = 0.0316) in all cases, but there was no significant difference after propensity score matching (p = 0.069). According to the histologic type in propensity score matching, the OS of signet ring cell carcinoma and poorly differentiated carcinoma patients did not differ between the ESD and surgery groups (p = 0.1189 and p = 0.3087, respectively). In the surgery group involving expanded criteria, lymph node metastasis was found in six cases (1.56%). Conclusions Although ESD shows comparable outcomes to surgery for the UD EGC within expanded indications, appropriate patient selection is needed for the ESD due to the possibility of lymph node metastasis. Keywords Endoscopic submucosal dissection · Surgery · Undifferentiated histology · Stomach · Treatment outcome
Introduction In early gastric cancer (EGC) patients, endoscopic submucosal dissection (ESD) has produced favorable long-term outcomes and the indication criteria for this procedure are widening [1, 2]. The expanded indications for ESD consist of three discrete criteria that have been used for EGC: I, intramucosal tumor, differentiated type, without ulcerative Ji Yong Ahn and Young-II Kim have contributed equally to this work as co-first authors. * Woon Geon Shin [email protected] Extended author information available on the last page of the article
findings, and > 2 cm in size; II, intramuco
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