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Comparison between endoscopic submucosal resection and surgery for the curative resection of undifferentiated-type early gastric cancer within expanded indications: a nationwide multi-center study

 Ji Yong Ahn  ;  Young-Ii Kim  ;  Woon Geon Shin  ;  Hyo-Joon Yang  ;  Su Youn Nam  ;  Byung-Hoon Min  ;  Jae-Young Jang  ;  Joo Hyun Lim  ;  Jie -Hyun Kim  ;  Wan Sik Lee  ;  Bong Eun Lee  ;  Moon Kyung Joo  ;  Jae Myung Park  ;  Hang Lak Lee  ;  Tae- Geun Gweon  ;  Moo In Park  ;  Jeongmin Choi  ;  Chung Hyun Tae  ;  Young-Woo Kim  ;  Boram Park  ;  I I Ju Choi 
 GASTRIC CANCER, Vol.24(3) : 731-743, 2021-05 
Journal Title
Issue Date
Adenocarcinoma / pathology ; Adenocarcinoma / surgery ; Carcinoma, Signet Ring Cell / pathology ; Carcinoma, Signet Ring Cell / surgery ; Disease-Free Survival ; Endoscopic Mucosal Resection ; Female ; Gastrectomy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local / pathology ; Neoplasm Recurrence, Local / surgery* ; Propensity Score ; Republic of Korea ; Retrospective Studies ; Stomach Neoplasms / pathology ; Stomach Neoplasms / surgery* ; Treatment Outcome
Endoscopic submucosal dissection ; Stomach ; Surgery ; Treatment outcome ; Undifferentiated histology
Background and aims: Endoscopic submucosal dissection (ESD) for undifferentiated early gastric cancer (UD EGC) has debate due to the risk of lymph node metastasis. We investigated the outcomes of ESD compared to those of surgery for the UD EGC within expanded indication.

Methods: We reviewed 971 UD EGC patients performed ESD across 18 hospitals in Korea and 1812 patients who underwent surgical resection in two hospitals between February 2005 and May 2015. Of these cases, we enrolled a curative resected ESD group of 328 patients and surgery group of 383 cases within an expanded indication. Overall outcomes and one-to-one propensity score-matched (218 ESD group vs 218 surgery group cases) outcomes for these two groups were analyzed.

Results: Over the 75.6 month median follow-up period for the 711 enrolled cases, recurrences occurred in 22 patients (6.7%) in the ESD group but not in the surgery group. Overall survival (OS) was higher in the surgery group (p = 0.0316) in all cases, but there was no significant difference after propensity score matching (p = 0.069). According to the histologic type in propensity score matching, the OS of signet ring cell carcinoma and poorly differentiated carcinoma patients did not differ between the ESD and surgery groups (p = 0.1189 and p = 0.3087, respectively). In the surgery group involving expanded criteria, lymph node metastasis was found in six cases (1.56%).

Conclusions: Although ESD shows comparable outcomes to surgery for the UD EGC within expanded indications, appropriate patient selection is needed for the ESD due to the possibility of lymph node metastasis.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
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