Lee GH, Lee E, Park B, Roh J, Lim SG, Shin SJ, Lee KM, Noh CK. Long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated intramucosal gastric cancer regardless of size. World J Gastroenterol 2022; 28(8): 840-852 [PMID: 35317100 DOI: 10.3748/wjg.v28.i8.840]
Corresponding Author of This Article
Choong-Kyun Noh, MD, PhD, Assistant Professor, Department of Gastroenterology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon 16499, South Korea. cknoh23@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 28, 2022; 28(8): 840-852 Published online Feb 28, 2022. doi: 10.3748/wjg.v28.i8.840
Long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated intramucosal gastric cancer regardless of size
Gil Ho Lee, Eunyoung Lee, Bumhee Park, Jin Roh, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee, Choong-Kyun Noh
Gil Ho Lee, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee, Choong-Kyun Noh, Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, South Korea
Eunyoung Lee, Bumhee Park, Department of Biomedical Informatics, Ajou University School of Medicine, Suwon 16499, South Korea
Jin Roh, Department of Pathology, Ajou University School of Medicine, Suwon 16499, South Korea
Author contributions: Lee GH and Lee E contributed equally to this work; Lee GH planned the study design, reviewed the data, analyzed the data and drafted the manuscript; Lee E and Park B analyzed and reviewed the statistical data; Roh J reviewed the pathologic data; Lim SG planned the study design and collected the data; Shin SJ and Lee KM interpreted the data and supervised the report; Noh CK conceptualized, drafted the manuscript and critically revised the manuscript; all the authors approved the final version of the article and agree to be accountable for all aspects of the work.
Institutional review board statement: The study protocol was approved by Ajou University Hospital Institution’s Review Board and Ethics Committee (Approval No. AJIRB-MED-MDB-21-101).
Informed consent statement: Patients were not required to give informed consent because the analysis used anonymous clinical data obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No potential conflicts of interest were disclosed.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Choong-Kyun Noh, MD, PhD, Assistant Professor, Department of Gastroenterology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon 16499, South Korea. cknoh23@gmail.com
Received: July 30, 2021 Peer-review started: July 30, 2021 First decision: August 19, 2021 Revised: August 30, 2021 Accepted: January 27, 2022 Article in press: January 21, 2022 Published online: February 28, 2022
ARTICLE HIGHLIGHTS
Research background
Endoscopic submucosal dissection (ESD) is performed as an alternative treatment modality for undifferentiated (UD) intramucosal early gastric cancer (EGC) who are within the expanded indication. However, the ESD role for UD intramucosal EGC with lesion size > 2 cm (the only non-curative factor) is still controversial compared with surgery.
Research motivation
Several studies showed ESD could be performed for patients with UD intramucosal EGC within the expanded indication. However, the role of ESD is limited in these patients because of the lesion size. Even if UD intramucosal EGC meets the criteria of expanded indications, additional surgical treatment is recommended if the lesion size alone is a non-curative factor (lesion diameter > 2 cm).
Research objectives
In this study, the authors compared ESD with surgery in patients with UD intramucosal EGC who meet both the within expanded indications or beyond expanded indications with lesion size > 2 cm (the only non-curative factor).
Research methods
The authors retrospectively analyzed patients with UD intramucosal EGC after ESD with complete resection or surgery. After propensity-score matching, clinical outcomes and long-term outcomes, i.e., recurrence-free survival (RFS) and overall survival (OS), were analyzed.
Research results
After propensity-scored matching, although ESD with complete resection was performed in UD intramucosal EGC regardless of lesion size, RFS increased, while there was no difference in OS compared to surgery. Especially, all cases of local recurrence were identified within 1 year in our study in the ESD group.
Research conclusions
Although ESD may be an alternative treatment option when surgery is not possible for UD intramucosal EGC with lesion sizes > 2 cm, endoscopic surveillance should be carefully performed within one year for local recurrence.
Research perspectives
Multicenter randomized studies with large cohorts are expected to evaluate ESD in patients with UD intramucosal EGC regardless of tumor size.
