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Clinical outcomes of endoscopic resection for undifferentiated intramucosal early gastric cancer larger than 2 cm

 Hyo-Joon Yang  ;  Su Youn Nam  ;  Byung-Hoon Min  ;  Ji Yong Ahn  ;  Jae-Young Jang  ;  Jung Kim  ;  Jie-Hyun Kim  ;  Wan-Sik Lee  ;  Bong Eun Lee  ;  Moon Kyung Joo  ;  Jae Myung Park  ;  Woon Geon Shin  ;  Hang Lak Lee  ;  Tae-Geun Gweon  ;  Moo In Park  ;  Jeongmin Choi  ;  Chung Hyun Tae  ;  Young-Il Kim  ;  Il Ju Choi 
 GASTRIC CANCER, Vol.24(2) : 435-444, 2021-03 
Journal Title
Issue Date
Aged ; Carcinoma / mortality ; Carcinoma / pathology* ; Endoscopic Mucosal Resection / methods ; Endoscopic Mucosal Resection / mortality* ; Female ; Gastrectomy / methods ; Gastrectomy / mortality* ; Gastric Mucosa / pathology ; Humans ; Lymph Nodes / pathology ; Lymphatic Metastasis ; Male ; Margins of Excision ; Middle Aged ; Neoplasm Metastasis ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Stomach Neoplasms / mortality ; Stomach Neoplasms / pathology* ; Stomach Neoplasms / surgery* ; Survival Rate ; Treatment Outcome ; Tumor Burden
Endoscopic mucosal resection ; Lymph node metastasis ; Stomach neoplasms ; Treatment outcome ; Undifferentiated-type histology
Background: This study investigated the long-term clinical outcomes of endoscopic resection (ER) for undifferentiated-type (UD) early gastric cancer (EGC), with tumor size > 2 cm as the only non-curative factor.

Methods: From among 1123 patients who underwent ER for UD EGC at 18 tertiary hospitals in Korea between 2005 and 2014, we identified 216 patients with UD intramucosal EGC > 2 cm, which was completely resected, with negative resection margins, and absence of ulceration and lymphovascular invasion. The patients were divided into the additional surgery (n = 40) or observation (n = 176) groups, according to post-ER management and were followed up for a median duration of 59 months for recurrence and 90 months for overall survival.

Results: Lymph node (LN) or distant metastasis or cancer-related mortality was not observed in the surgery group. In the observation group, two (1.1%) patients developed LN or distant metastasis with a 5-year cumulative risk of 0.7%, and one (0.6%) patient died of gastric cancer. The 5- and 8-year overall survival rates were 94.1% and 89.9%, respectively, in the observation group and 100.0% and 95.2%, respectively, in the surgery group (log-rank P = 0.159). Cox regression analysis did not reveal an association between the observation group and increased mortality.

Conclusion: The risk of LN or distant metastasis was not negligible, but as low as 1% for patients undergoing non-curative ER for UD EGC, with tumor size > 2 cm as the only non-curative factor. Close observation may be an alternative to surgery, especially for older patients or those with poor physical status.
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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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