Clinical Outcomes of Endoscopic Submucosal Dissection for Undifferentiated or Submucosal Invasive Early Gastric Cancer
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Background/Aims: Early gastric cancer (EGC) that is undifferentiated or shows submucosal invasion has not been generally accepted as an indication for endoscopic treatment. But recently, experiences with endoscopic submucosal dissection (ESD) for undifferentiated EGC or submucosal invasive (SM) EGC have increased. The aim of this study was to evaluate clinical outcomes of ESD for EGC with undifferentiation or submucosal invasion. Methods: Between August 2005 and August 2009, among 210 EGCs treated using ESD at our hospital, 18 lesions were diagnosed as undifferentiated gastric cancer and 41 as SM gastric cancer. A retrospective analysis was done on the medical records of these patients. Results: Mean follow-up periods were 19.39±11.2 months. During the follow-up period, local recurrence was noted in 4 lesions. Local recurrence rates of the EGC groups (group 1, mucosal cancer with undifferentiation; group 2, SM cancer with differentiation; group 3, SM cancer with undifferentiation) were 10%, 4.5%, and 50%, respectively. Groups 1 and 2 were not significantly different in local recurrence rates compared to the mucosal cancer with differentiation group (p=0.061, p=0.125, respectively). The undifferentiated EGC group was significantly lower in curability using ESD than the differentiated EGC group (55.6% vs. 89.6%, p=0.000). The curability of the SM EGC group was lower than the mucosal EGC group (36.6% vs. 98.9%). Conclusions: Complete resection using ESD is difficult in undifferentiated and SM gastric cancers. SM cancer with undifferentiation should be treated immediately by salvage operation. For mucosal cancer with undifferentiation or SM cancer with differentiation, one should consider careful short-term follow-up.
Abstract
Background/Aims: Early gastric cancer (EGC) that is undifferentiated or shows submucosal invasion has not been generally accepted as an indication for endoscopic treatment. But recently, experiences with endoscopic submucosal dissection (ESD) for undifferentiated EGC or submucosal invasive (SM) EGC have increased. The aim of this study was to evaluate clinical outcomes of ESD for EGC with undifferentiation or submucosal invasion. Methods: Between August 2005 and August 2009, among 210 EGCs treated using ESD at our hospital, 18 lesions were diagnosed as undifferentiated gastric cancer and 41 as SM gastric cancer. A retrospective analysis was done on the medical records of these patients. Results: Mean follow-up periods were 19.39±11.2 months. During the follow-up period, local recurrence was noted in 4 lesions. Local recurrence rates of the EGC groups (group 1, mucosal cancer with undifferentiation; group 2, SM cancer with differentiation; group 3, SM cancer with undifferentiation) were 10%, 4.5%, and 50%, respectively. Groups 1 and 2 were not significantly different in local recurrence rates compared to the mucosal cancer with differentiation group (p=0.061, p=0.125, respectively). The undifferentiated EGC group was significantly lower in curability using ESD than the differentiated EGC group (55.6% vs. 89.6%, p=0.000). The curability of the SM EGC group was lower than the mucosal EGC group (36.6% vs. 98.9%). Conclusions: Complete resection using ESD is difficult in undifferentiated and SM gastric cancers. SM cancer with undifferentiation should be treated immediately by salvage operation. For mucosal cancer with undifferentiation or SM cancer with differentiation, one should consider careful short-term follow-up.
참고문헌 (19)
- Tada M, "Endoscopic resection of early gastric cancer", Endoscopy, 25, pp.445~450 (1993)
- Hwoon-Yong Jung, "Expansion of Indication for Endoscopic SD in Early Gastric Cancer", 대한위암학회지, 10(2), pp.49~54 (2010), 대한위암학회
- Cai J, "Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer", Surgery, 127, pp.32~39 (2000)
- Cai J, "Micrometastasis in lymph nodes of mucosal gastric cancer", Gastric Cancer, 3, pp.91~96 (2000)
- Yanai H, "Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer: a pilot study", Gastrointest Endosc, 46, pp.212~216 (1997)
- 박은희, "위선종과 조기위암에서 내시경 점막하 박리법 전후 조직 소견의 차이", Clinical Endoscopy, 34(3), pp.125~131 (2007), 대한소화기내시경학회
- 김경미, "내시경절제의 위암병리; 어떻게 판독하나", 대한소화기학회지, 56(4), pp.214~219 (2010), 대한소화기학회
- "The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon", Gastrointest Endosc, 58, pp.S3~S43 (2002)
- Kim JH, "Endoscopic resection for undifferentiated early gastric cancer", Gastrointestinal Endoscopy, 69(4), pp.e1~e9, Mosby Inc.
- Park DJ, "Lymph node metastasis in early gastric cancer with submucosal invasion: Feasibility of minimally invasive surgery", World Journal of Gastroenterology, 10(24), pp.3549~3552 (2004), W J G Press
- Abe N, "Endoscopic treatment or surgery for undifferentiated early gastric cancer?", Am J Surg, 188, pp.181~184 (2004)
- Nasu J, "Predictive factors of lymph node metastasis in patients with undifferentiated early gastric cancers", J Clin Gastroenterol, 40, pp.412~415 (2006)
- Park YD, "Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach", ENDOSCOPY, 40, pp.7~10 (2008), GEORG THIEME VERLAG KG
- Namieno T, "General pattern of lymph node metastasis in early gastric carcinoma", World J Surg, 20, pp.996~1000 (1996)
- Yasuda K, "Rate of detection of lymph node metastasis is correlated with the dep-th of submucosal invasion in early stage gastric carcinoma", Cancer, 85, pp.2119~2123 (1999)
- Kang HY, "Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer", Surg Endosc, 24, pp.509~516 (2010)
- Park JC, "Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience", SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 24(11), pp.2842~2849 (2010), SPRINGER
- 배정민, "위암으로 내시경적 절제술 후 추가적인 위절제술을 시행 받은 환자들의 임상병리학적 특징", 대한외과학회지, 78(2), pp.87~92 (2010), 대한외과학회
- Takenaka R, "Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection", Gastrointest Endosc, 68, pp.887~894 (2008)