Feasibility of further expansion of the indications for endoscopic submucosal dissection in undifferentiated-type early
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ORIGINAL ARTICLE
Feasibility of further expansion of the indications for endoscopic submucosal dissection in undifferentiated‑type early gastric cancer Yusuke Horiuchi1 · Satoshi Ida2 · Noriko Yamamoto3 · Souya Nunobe2 · Naoki Ishizuka4 · Shoichi Yoshimizu1 · Akiyoshi Ishiyama1 · Toshiyuki Yoshio1 · Toshiaki Hirasawa1 · Tomohiro Tsuchida1 · Koshi Kumagai2 · Manabu Ohashi2 · Takeshi Sano2 · Junko Fujisaki1 Received: 27 July 2019 / Accepted: 27 August 2019 © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019
Abstract Background Based on Japanese guidelines for endoscopic submucosal dissection (ESD) in undifferentiated-type early gastric cancer (UD-EGC), UD-predominant mixed-type (M-UD) EGC is considered high risk for lymph node metastasis (LNM). However, differences in LNM risk between pure UD (P-UD) and M-UD remain unclear. This study assessed risk factors for LNM considering differences between P-UD and M-UD and identified pathological features related to the lowest LNM risk. Methods This single-center, retrospective study included 1425 patients with UD-EGC treated with surgical resection between April 2005 and May 2017. We divided patients into those with and without LNM and compared background characteristics and post-operative pathological results between groups. Patients were further stratified based on depth, tumor diameter, ulcerative findings, lymphatic invasion, vascular invasion, and histological type to clarify post-operative pathological features associated with the lowest LNM risk. Results When comparing background characteristics and post-operative pathological results, multivariate analysis showed that, in patients with LNM, tumor diameters were significantly larger, and there were higher rates of submucosal invasion, lymphatic invasion, and M-UD histological type. In patients with absence of ulcerative findings, absence of lymphatic invasion, and absence of vascular invasion, no LNM occurred among those with intramucosal P-UD tumor diameters of 1–40 mm (1–20 mm: 95% confidence interval [CI], 0–5.5%; 21–40 mm: 95% CI, 0–6.1%). Conclusions Intramucosal P-UD EGC patients with absence of ulcerative findings, absence of lymphatic invasion, absence of vascular invasion, and tumor diameters of ≤ 40 mm did not show LNM. We suggest expanding indications for ESD to include these patients. Keywords Gastric cancer · Endoscopic submucosal resection · Gastric carcinoma · Lymph node metastasis
Introduction
* Yusuke Horiuchi [email protected] 1
Department of Gastroenterology, Cancer Institute Hospital, 3‑10‑6 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
2
Department of Gastric Surgery, Cancer Institute Hospital, 3‑10‑6 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
3
Department of Pathology, Cancer Institute Hospital, 3‑10‑6 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
4
Department of Clinical Trial Planning and Management, Cancer Institute Hospital, 3‑10‑6 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
Since the development of endoscopic submucosal resection (ESD)
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