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A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer

 Hyuk Lee  ;  Won Kyoung Yun  ;  Jae J. Kim  ;  Jong Chul Rhee  ;  Kyoung Mee Kim  ;  Poong-Lyul Rhee  ;  Jun Haeng Lee  ;  Byung-Hoon Min 
 Surgical Endoscopy , Vol.25(6) : 1985-1993, 2011 
Journal Title
 Surgical Endoscopy  
Issue Date
BACKGROUND: Endoscopic submucosal dissection (ESD) is the standard treatment for selected cases of early gastric cancer (EGC). Evolution of ESD techniques and accessories has expanded treatment indications. The aim of this study was to compare the therapeutic outcomes for conventional and expanded indications of ESD for EGC. METHODS: Eight hundred six EGC lesions in 780 patients were classified into two groups based on a pathological review: a conventional indication group (595 cases) and an expanded indication group (211 cases). The expanded indication group was classified further into subgroups according to tumor depth and tumor size. Therapeutic outcomes were compared between the conventional and expanded indication groups and between the expanded indication subgroups. RESULTS: The complete resection rate (97.3% vs. 81.0%, p<0.001) and en bloc complete resection rate (95.6% vs. 79.1%, p=0.003) were higher in the conventional indication group than in the expanded indication group. Among the expanded indication patients, the complete resection rate (64.5% vs. 91.1%, p<0.001) and en bloc complete resection rate (63.2% vs. 89.6%, p<0.001) were lower in the submucosal invasion subgroup than in the mucosal invasion subgroup. The complete resection rate and en bloc complete resection rate did not differ between subgroups classified according to tumor size in the expanded indication group. The conventional indication group and expanded indication group did not differ with regard to the rates of local recurrence (0.7% vs. 0%), metachronous recurrence (3.6% vs. 3.3%), or cumulative disease-free survival. Survival outcome was similar in the subgroups classified by tumor depth and size. Perforation was more frequent in the expanded indication group than in the conventional indication group (6.6% vs. 2.4%, p<0.001). CONCLUSION: ESD for expanded indication of EGC had acceptable clinical outcomes. ESD can be applied safely to properly selected patients with EGC.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
이혁(Lee, Hyuk)
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