Weng CY, Sun SP, Cai C, Xu JL, Lv B. Endoscopic submucosal dissection for early signet ring cell gastric cancer: A systematic review and meta-analysis. World J Clin Cases 2022; 10(20): 6915-6926 [PMID: 36051146 DOI: 10.12998/wjcc.v10.i20.6915]
Corresponding Author of This Article
Bin Lv, MD, Chief Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. lvbin@medmail.com.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Meta-Analysis
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 Clin Cases. Jul 16, 2022; 10(20): 6915-6926 Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6915
Endoscopic submucosal dissection for early signet ring cell gastric cancer: A systematic review and meta-analysis
Chun-Yan Weng, Shao-Peng Sun, Chang Cai, Jing-Li Xu, Bin Lv
Chun-Yan Weng, Shao-Peng Sun, Chang Cai, Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Jing-Li Xu, Department of Gastrointestinal Surgery, The First Clinical Medical University of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Bin Lv, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Weng CY, Cai C, and Sun SP collected the data; Weng CY, Xu JL, and Lv B wrote the draft of the article; all authors contributed to offered critical revisions, and have read and approved the manuscript.
Supported byNational Natural Science Foundation of China, No. 8177030774.
Conflict-of-interest statement: The authors have no conflicts of interest or financial ties to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Bin Lv, MD, Chief Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. lvbin@medmail.com.cn
Received: September 6, 2021 Peer-review started: September 6, 2021 First decision: November 7, 2021 Revised: November 11, 2021 Accepted: April 21, 2022 Article in press: April 21, 2022 Published online: July 16, 2022
Abstract
BACKGROUND
The use of endoscopic submucosal dissection (ESD) for treating early signet ring cell carcinoma (SRC) is controversial due to the risk of lymph node metastasis.
AIM
To carry out a meta-analysis to evaluate ESD for therapeutic efficacy and safety in early signet ring cell gastric cancer.
METHODS
The PubMed, Web of Science, Cochrane Library, and EMBASE databases were used to search for relevant studies evaluating the therapeutic efficacy and safety of ESD in SRC. The rates of recurrence, complete resection, incomplete resection, curative resection, en bloc resection, and adverse events were extracted and analyzed. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated by the Egger’s test. Institutional review board approval and written consent were not needed for this report.
RESULTS
This meta-analysis enrolled seven studies with 653 participants undergoing ESD treatment for early SRC. The overall recurrence rate was 0.010 [95% confidence interval (CI): 0.000-0.040, Z = 1.422, P = 0.155]. The total lymphovascular invasion rate was 0.038 (95%CI: 0.007-0.088, Z = 3.026, P = 0.002). The total en bloc resection rate was estimated at 0.984 (95%CI: 0.925-1.000, Z = 19.463, P = 0.000). The total complete and incomplete resection rates were estimated at 0.785 (95%CI: 0.596-0.928, Z = 9.789, P = 0.000) and 0.188 (95%CI: 0.016-0.468, Z = 2.531, P = 0.011), respectively. The total procedure-associated gastric hemorrhage and perforation rates were estimated at 0.026 (95%CI: 0.005-0.061, Z = 3.006 P = 0.003) and 0.004 (95%CI: 0.000-0.028, Z = 0.938, P = 0.348), respectively. The curative resection, vertical margin invasion, and lateral margin invasion rates were 72.1% (145/341), 2.3% (8/348), and 34.45% (41/119), respectively.
CONCLUSION
ESD constitutes a promising therapeutic approach for early undifferentiated SRC gastric cancer. However, further improvements are required for increasing its treatment efficacy and reducing adverse outcomes.
Core Tip: Endoscopic submucosal dissection (ESD) is widely used as a curative treatment for early gastric cancer (EGC), whereas its efficacy and safety remain unclear. Totally 653 participants were included in this meta-analysis assessing the therapeutic efficacy and safety of ESD in EGC. Based on the data collected and presented, we conclude that ESD is a promising treatment option for undifferentiated signet ring cell carcinoma EGC. Large, long-term trials are warranted to confirm the current results.
