Outcomes of endoscopic submucosal dissection for differentiated-type early gastric cancer with histological heterogeneity

Abstract

Background Long-term clinical outcomes after endoscopic submucosal dissection (ESD) is unclear for differentiated-type-predominant early gastric cancer (EGC) mixed with undifferentiated component (MUC-EGC). Therefore, the role and appropriate indication of ESD for MUC-EGC remain to be evaluated. Methods Between 2007 and 2011, 1,577 differentiatedtype EGC lesions [1,408 pure differentiated-type (PuD)-EGCs and 169 MUC-EGCs] in 1,527 consecutive patients were treated by ESD. After ESD, MUC-EGC was managed in the same way as PuD-EGC. The clinicopathological features and long-term outcomes after ESD of MUC-EGC were compared with those of PuD-EGC. Results En bloc resection and en bloc with R0 resection rates in MUC-EGC cases were 94.1 % and 81.7 %, respectively. MUC-EGC was significantly associated with larger tumor size, more frequent submucosal invasion, and lymphovascular invasion compared to PuD-EGC. Despite these aggressive features of MUC-EGC, no lymph node metastasis or extragastric recurrence occurred during follow-up after ESD if MUC-EGC met the curative endoscopic resection (ER) criteria for tumors of absolute or expanded indications. Four MUC-EGC cases meeting the curative ER criteria underwent additional radical gastrectomy after ESD, and no case showed lymph node metastasis. During a median 48 months of follow-up, overall survival rates for MUC-EGC meeting the curative ER criteria for tumors of absolute or expanded indications (3-year survival rates, 100 % and 100 %) were comparable to those of PuD-EGC. Conclusions Long-term outcomes after ESD were favorable for MUC-EGCs meeting the curative ER criteria for tumors of absolute or expanded indications. Therefore, ESD may be used as a promising treatment option for these cases.

Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study

“…In early gastric adenocarcinomas combined with signet‐ring cell carcinoma (diffuse), the frequency of LNM is greatly increased to over 20%, as reported in single‐center cohorts from Korea, Japan, and China. This risk appears to be significantly associated with a large tumor size, more frequent submucosal infiltration and lymphovascular invasion . This important finding was confirmed in this multicenter study as an independent risk factor for LNM.…”

“…This risk appears to be significantly associated with a large tumor size, more frequent submucosal infiltration and lymphovascular invasion. 30,31 This important finding was confirmed in this multicenter study as an independent risk factor for LNM. Thus, endoscopic therapy, such as ESD, may not be indicated for this uncommon type of EGC.…”

Is preoperative staging enough to guide lymph node dissection in clinically early gastric cancer?

“…In contrast to the previous related studies that adopted a postoperative histological classification with differentiated and undifferentiated types [22,23], this study divided the preoperative histological classification into WD and MD ? PD groups in the multivariate analysis because of the similar incidence of LNM between preoperative MD and PD groups.…”

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

“…Neither the characteristics nor feasibility of ESD for this type of EGC have been settled [44][45][46] . As previously mentioned, the discrepancy between preand post-ESD histology could be a problem in the assessment of surgery indications or the risk of lymph node metastasis.…”