Bae JY, Ryu CB, Lee MS, Dua KS. Long-term outcomes of endoscopic submucosal dissection for undifferentiated type early gastric cancer over 2 cm with R0 resection. World J Gastrointest Endosc 2024; 16(6): 326-334 [PMID: 38946856 DOI: 10.4253/wjge.v16.i6.326]
Corresponding Author of This Article
Chang Beom Ryu, MD, PhD, Professor, Internal Medicine and Digestive Disease Center and Research Institute, Soon Chun Hyang University of School of Medicine, 170 Jomaru-ro, Bucheon-si, Gyeonggi-do, Bucheon 14584, South Korea. ryuchb@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 Gastrointest Endosc. Jun 16, 2024; 16(6): 326-334 Published online Jun 16, 2024. doi: 10.4253/wjge.v16.i6.326
Long-term outcomes of endoscopic submucosal dissection for undifferentiated type early gastric cancer over 2 cm with R0 resection
Jun Yong Bae, Chang Beom Ryu, Moon Sung Lee, Kulwinder S Dua
Jun Yong Bae, Internal Medicine and Digestive Disease Center, Seoul Medical Center, Seoul 02053, South Korea
Chang Beom Ryu, Moon Sung Lee, Internal Medicine and Digestive Disease Center and Research Institute, Soon Chun Hyang University of School of Medicine, Bucheon 14584, South Korea
Kulwinder S Dua, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Author contributions: Bae JY, Ryu CB, and Lee MS contributed to conceptualization; Bae JY and Ryu CB contributed to Data curation; Bae JY, Ryu CB contributed to manuscript writing-original draft; Bae JY, Ryu CB, Lee MS and Dua KS contributed to manuscript review and editing; All authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the ethical committee of the Medical Center (IRB No. 2018-07-028).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no potential conflicts of interest.
Data sharing statement: We have not received consent to share data from the IRB, and we cannot share data because it may cause more harm than potential benefit.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang Beom Ryu, MD, PhD, Professor, Internal Medicine and Digestive Disease Center and Research Institute, Soon Chun Hyang University of School of Medicine, 170 Jomaru-ro, Bucheon-si, Gyeonggi-do, Bucheon 14584, South Korea. ryuchb@gmail.com
Received: January 21, 2024 Revised: February 24, 2024 Accepted: May 8, 2024 Published online: June 16, 2024 Processing time: 145 Days and 0.7 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) for over 2 cm in size undifferentiated type (UD type) early gastric cancer (EGC) confined to the mucosa is not only challenging, but also long-term outcomes are not well known.
AIM
To evaluate the long-term outcomes of ESD done for UD type EGCs confined to the mucosa over 2 cm in size and compare the results with those where the lesions were less than 2 cm.
METHODS
143 patients with UD type EGC confirmed on histology after ESD at a tertiary hospital were reviewed. Cases with synchronous and metachronous lesions and a case with emergency surgery after ESD were excluded. A total of 137 cases were enrolled. 79 cases who underwent R0 resection were divided into 2 cm or less (group A) and over 2 cm (group B) in size.
RESULTS
Among 79 patients who underwent R0 resection, the number in group A and B were 51 and 28, respectively. The mean follow-up period (SD) was 79.71 ± 45.42 months. There was a local recurrence in group A (1/51, 2%) and group B (1/28, 3.6%) respectively. This patient in group A underwent surgery while the patient in group B underwent repeated ESD with no further recurrences in both patients. There was no regional lymph node metastasis, distant metastasis, and deaths in both groups. With R0 resection strategy for ESD on lesions over 2 cm, 20.4% (28/137) of patients were able to avoid surgery compared with expanded indication.
CONCLUSION
If R0 resection is achieved by ESD, UD type EGCs over 2 cm also showed good and similar clinical outcomes as compared to lesions less than 2 cm when followed for over 5 years. With R0 resection strategy, several patients can avoid surgery.
Core Tip: The long-term outcomes of endoscopic submucosal dissection (ESD) in undifferentiated (UD) type early gastric cancer (EGC) over 2 cm confined to the mucosa are not well known. In our study, R0 resection is achieved by ESD in these patients also showed good long-term clinical outcomes similar to lesions if less than 2 cm. With R0 resection strategy, 20.4% of patients were able to avoid surgery compared with expanded indication. Further prospective randomized studies are recommended to determine which UD type EGCs over 2 cm are suitable for endoscopic treatment.
