Expansion of Indications for Endoscopic Treatment of Undifferentiated Mucosal Gastric Cancer: Analysis of Intramucosal Spread in Resected Specimens

Sawada, Susumu S.; Fujisaki, Junko; Yamamoto, Norio; Kato, You; Ishiyama, Akiyoshi; Ueki, Nobue; Hirasawa, Toshiaki; Yamamoto, Yorimasa; Tsuchida, Takaaki; Tatewaki, Makoto; Hoshino, Etsuo; Igarashi, Masahiro; Takahashi, Hiroshi; Fujita, Rikiya

doi:10.1007/s10620-009-0883-4

Cited by 30 publications

(21 citation statements)

References 2 publications

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“…A more serious problem is the difficulty in determining tumor extent and depth of invasion of EGC with undifferentiated-type histology. EGC with undifferentiated-type histology is known to extend laterally along the proliferative zone in the intermediate layer of mucosa and the development pattern from the intermediate layer type to the superficial type makes non-exposure to the surface mucosa [42] . The accuracy of EUS in the assessment of depth of invasion for EGC with undifferentiated-type histology is known to be declining compared to intestinal type EGC [43] .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Bang¹,

Baik²,

Is³

et al. 2015

WJG

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Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Bang¹,

Baik²,

Is³

et al. 2015

WJG

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“…Also, with diagnosis of the extent of the lesion, it is relatively easy to determine if discoloration occurs in the background mucosa of mild atrophy. However, in lesions with a background mucosa which had severe atrophy and inflammation, it was quite difficult to diagnose the extent of disease even when using magnified endoscopy with NBI [20,21,22]. In addition, the multiple circumferential biopsies are also useful, but care must be taken if lesions progress discontinuously.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Undifferentiated Early Gastric Cancer as the Expanded Indication Lesion

Kamada¹,

Tomatsuri²,

Yoshida³

2012

Digestion

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Background: Endoscopic submucosal dissection (ESD) has become the standard endoscopic treatment for early gastric cancer without lymph node metastasis. At present, undifferentiated type intramucosal cancers without ulcer findings <20 mm in size are often chosen as endoscopic treatment lesions for expanded indication. The purpose of this study was to examine the outcome of ESD treatment in undifferentiated carcinomas. Method: Forty-six patients who had undergone ESD from July 2002 until July 2010, where the final pathological diagnosis was undifferentiated carcinoma, were assessed for the en-bloc resection ratio, the accuracy rate of depth or extent of diagnosis and survival. Results: In endoscopic ultrasonography studies, the accuracy rate of mucosal lesions was 86%. The rate of en-bloc resection was 91% (42/46) and 5 cases had a positive margin. Four cases had a positive margin in cases of piecemeal resection. Five cases underwent additional surgery, and residual cancer was found in 1 case. There were 2 cases of perforation, 2 of delayed hemorrhage, and no cases of delayed perforation. One case died of multiple liver metastases and 1 died of hepatocellular carcinoma. After a maximum of 8 years, an average of 3.8 years of observation, including 7 cases who had undergone additional surgery, recurrence occurred in only 1 case of liver metastasis. Conclusion: In this study the lesions of undifferentiated adenocarcinoma, which were limited to the mucosa, <20 mm in diameter and had been completely resected, showed no recurrence and were indicated for endoscopic treatment.

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“…[23,24] It is also reported that procedure-related complications increase in undifferentiated or SM invasion. [25] In this study, there was no difference in the SM invasion (7.7% vs 5.4%, P = .611) and undifferentiated group (7.9% vs 5.4%, P = .662) compared with absolute indication group.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome after endoscopic submucosal dissection for early gastric cancer of absolute and expanded indication

Kim

Kang²,

Moon³

et al. 2017

Medicine

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This study evaluated the clinical outcome of endoscopic submucosal dissection (ESD) in minute submucosa (SM) invasion or undifferentiated early gastric cancer (EGC) and analyzed factors related to local recurrence after ESD.We retrospectively reviewed the chart of EGC patients, who underwent ESD at our tertiary hospital between January 2009 and 2015. The patients’ characteristics and clinical outcomes were compared among an absolute indication, minute SM invasion, and undifferentiated EGC group.Of 885 total patients, 729 composed the absolute indication group; 65, the differentiated, SM invasion group; and 51, the undifferentiated, confined mucosa group. Follow-up was conducted for average (± standard deviation) 34.12 (± 10.6) months; as compared to the absolute indication group, both en bloc resection and curative resection rate were low in the other 2 groups, but there were no significant differences in procedure-related complication, local recurrence, and survival rate. Comparing the cases of ESD performed at our hospital from 2005 to 2009 with those performed between 2009 and 2015, en bloc resection (80.5% vs 89.1%, P = .001) and curative resection rate (86.2% vs 92.1%, P = .011) were higher in the latter study. Noncurative resection and tumor size of more than 2 cm were factors associated with local recurrence.ESD in minute SM invasion or undifferentiated EGC showed an unfavorable short-term outcome as compared to that in the absolute indication group, but there were no differences in local recurrence and overall survival rate. Therefore, in minute SM invasion or undifferentiated EGC patients, ESD could be recommended as a therapeutic option.

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Expansion of Indications for Endoscopic Treatment of Undifferentiated Mucosal Gastric Cancer: Analysis of Intramucosal Spread in Resected Specimens

Cited by 30 publications

References 2 publications

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Endoscopic Submucosal Dissection for Undifferentiated Early Gastric Cancer as the Expanded Indication Lesion

Clinical outcome after endoscopic submucosal dissection for early gastric cancer of absolute and expanded indication

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