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Long‐term outcome after endoscopic submucosal dissection for early gastric cancer: Focusing on a group beyond the expanded indication
Author(s) -
Kang Myung Soo,
Hong Su Jin,
Kim Dae Yong,
Han Jae Pil,
Choi Moon Han,
Kim Hee Kyung,
Ko Bong Min,
Lee Moon Sung
Publication year - 2015
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12208
Subject(s) - medicine , endoscopic submucosal dissection , cancer , term (time) , outcome (game theory) , general surgery , surgery , gastroenterology , physics , mathematics , mathematical economics , quantum mechanics
Objective To determine the long‐term outcome after endoscopic submucosal dissection ( ESD ) in patients with early gastric cancer ( EGC ) according to the pathological extent. Methods ESD were performed in 280 patients with 309 EGC . The tumors were classified by pathological severity based on absolute indication ( AI ), expanded indication ( EI ) or beyond expanded indication ( BEI ). The therapeutic outcomes among the three groups were analyzed. Results The complete resection rates of EGC were 96.4%, 78.7% and 41.2% in the AI ‐ EGC , EI ‐ EGC and BEI ‐ EGC groups, respectively ( P = 0.000). En bloc resection rates were 97.6%, 87.4% and 86.3% in the AI ‐ EGC , EI ‐ EGC and BEI ‐ EGC groups, respectively ( P = 0.023). The 5‐year tumor recurrence rates were 1.8%, 1.5% and 15.4% in the AI ‐ EGC , EI ‐ EGC and BEI ‐ EGC groups, respectively ( P = 0.000). The 5‐year disease‐specific survival rates were 100%, 100% and 97.4% in the AI ‐ EGC , EI ‐ GEC and BEI ‐ EGC groups, respectively ( P = 0.088). The 5‐year disease‐free survival rates were 98.2%, 98.5% and 84.6% in the AI ‐ EGC , EI ‐ EGC and BEI ‐ EGC groups, respectively ( P = 0.000). Conclusions ESD was effective and safe in treating AI ‐ EGC and EI ‐ EGC , but there was a comparatively high rate of recurrence after ESD in the BEI ‐ EGC group. However, long‐term outcomes of patients with BEI ‐ EGC that did not receive additional surgery were better than those with an natural course of EGC . Thus, ESD may be considered for specific BEI ‐ EGC patients at high risk for surgery.