Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1086-E1096
DOI: 10.1055/a-1381-7013
Original article

Long- and short-term outcomes of early gastric cancer after endoscopic resection: a retrospective study from China

Qing-Wei Zhang‡
1   Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
,
Jin-Nan Chen‡
1   Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
,
Zhao-Rong Tang‡
2   Department of Gastroenterology and Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
,
Yun-Jie Gao
1   Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
,
Zhi-Zheng Ge   **
1   Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
,
Xiao-Bo Li   **
1   Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims The aim of the study was to evaluate short- and long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in China because no study has yet been conducted to confirm its effectiveness in EGC in China.

Patients and methods A total of 570 EGC samples from 537 patients were collected for evaluation of en bloc, complete, and curative resection using ESD. Data from 302 patients with at least 3 years of active follow-up were collected for analysis of recurrence of EGC and occurrence of metachronous GC (MGC). Short- and long-outcomes of mixed-type and pure differentiated EGC were also compared.

Results En bloc resection rates of 96.0 %, 98.7 %, and 95.2 %, complete resection rates of 91.2 %, 96.6 % and 90.8 %, and curative resection rates of 83.0 %, 96.2 % and 88.2 % were achieved in all EGCs included in the study, those with absolute indication, and those with expanded indication, respectively. As a long-term outcome, recurrence was observed in 1.3 % of patients, 3-year and 5-year recurrence rates being 0.7 % and 1.2 %, respectively. Thirteen patients (4.3 %) exhibited MGCs during follow-up, all of which were resected in a second ESD.

Conclusions The effectiveness of ESD for EGC in China was confirmed, with satisfactory short- and long-term outcomes. With scheduled follow-up, the outcomes for mixed-type EGC can be similar to those for pure differentiated EGC after complete resection without development of lymphovascular invasion.

** These authors contributed equally.


Supplementary material



Publication History

Received: 17 February 2020

Accepted: 18 December 2020

Article published online:
21 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Oda I, Saito D, Tada M. et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006; 9: 262-270
    CrossrefPubMedGoogle Scholar
  • 2 Tanabe S, Hirabayashi S, Oda I. et al. Gastric cancer treated by endoscopic submucosal dissection or endoscopic mucosal resection in Japan from 2004 through 2006: JGCA nationwide registry conducted in 2013. Gastric Cancer 2017; 20: 834-842
    CrossrefPubMedGoogle Scholar
  • 3 Lian J, Chen S, Zhang Y. et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 2012; 76: 763-770
    CrossrefPubMedGoogle Scholar
  • 4 Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M. et al. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc 2009; 69: 350-355
    CrossrefPubMedGoogle Scholar
  • 5 Emura F, Mejia J, Donneys A. et al. Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video). Gastrointest Endosc 2015; 82: 804-811
    CrossrefPubMedGoogle Scholar
  • 6 Probst A, Schneider A, Schaller T. et al. Endoscopic submucosal dissection for early gastric cancer: are expanded resection criteria safe for Western patients?. Endoscopy 2017; 49: 855-865
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Abdelfatah MM, Barakat M, Lee H. et al. The incidence of lymph node metastasis in early gastric cancer according to the expanded criteria in comparison with the absolute criteria of the Japanese Gastric Cancer Association: a systematic review of the literature and meta-analysis. Gastrointest Endosc 2018; 87: 338-347
    CrossrefPubMedGoogle Scholar
  • 8 Choi AH, Nelson RA, Merchant SJ. et al. Rates of lymph node metastasis and survival in T1a gastric adenocarcinoma in Western populations. Gastrointest Endosc 2016; 83: 1184-1192 e1181
    CrossrefPubMedGoogle Scholar
  • 9 Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14: 113-123
    CrossrefPubMedGoogle Scholar
  • 10 Song WC, Qiao XL, Gao XZ. A comparison of endoscopic submucosal dissection (ESD) and radical surgery for early gastric cancer: a retrospective study. World J Surg Oncol 2015; 13: 309
    CrossrefPubMedGoogle Scholar
  • 11 Chiu PW, Teoh AY, To KF. et al. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc 2012; 26: 3584-3591
    CrossrefPubMedGoogle Scholar
  • 12 Fu QY, Cui Y, Li XB. et al. Relevant risk factors for positive lateral margin after en bloc endoscopic submucosal dissection for early gastric adenocarcinoma. J Dig Dis 2016; 17: 244-251
    CrossrefPubMedGoogle Scholar
  • 13 Zhang Y, Huang L, Li L. et al. Endoscopic submucosal dissection for early gastric neoplasms in elderly patients. J Laparoendosc Adv Surg Tech A 2014; 24: 391-398
    CrossrefPubMedGoogle Scholar
  • 14 Park HK, Lee KY, Yoo MW. et al. Mixed Carcinoma as an Independent Prognostic Factor in Submucosal Invasive Gastric Carcinoma. J Korean Med Sci 2016; 31: 866-872
    CrossrefPubMedGoogle Scholar
  • 15 Seo HS, Lee GE, Kang MG. et al. Mixed Histology Is a Risk Factor for Lymph Node Metastasis in Early Gastric Cancer. J Surg Res 2018; 236: 271-277
    CrossrefPubMedGoogle Scholar
  • 16 Takizawa K, Ono H, Kakushima N. et al. Risk of lymph node metastases from intramucosal gastric cancer in relation to histological types: how to manage the mixed histological type for endoscopic submucosal dissection. Gastric Cancer 2013; 16: 531-536
    CrossrefPubMedGoogle Scholar
  • 17 Han JP, Hong SJ, Kim HK. Long-term outcomes of early gastric cancer diagnosed as mixed adenocarcinoma after endoscopic submucosal dissection. J Gastroenterol Hepatol 2015; 30: 316-320
    CrossrefPubMedGoogle Scholar
  • 18 Horiuchi Y, Fujisaki J, Yamamoto N. et al. Mixed poorly differentiated adenocarcinoma in undifferentiated-type early gastric cancer predicts endoscopic noncurative resection. Gastric Cancer 2018; 21: 689-695
    CrossrefPubMedGoogle Scholar
  • 19 Min BH, Kim KM, Park CK. et al. Outcomes of endoscopic submucosal dissection for differentiated-type early gastric cancer with histological heterogeneity. Gastric Cancer 2015; 18: 618-626
    CrossrefPubMedGoogle Scholar
  • 20 Japanese Gastric Cancer A. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-112
    CrossrefPubMedGoogle Scholar
  • 21 Kim WH, Park CK, Kim YB. et al. A Standardized Pathology Report for Gastric Cancer. The Korean Journal of Pathology 2005; 39: 106-113
    PubMedGoogle Scholar
  • 22 Isomoto H, Shikuwa S, Yamaguchi N. et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
    CrossrefPubMedGoogle Scholar
  • 23 Abe S, Oda I, Suzuki H. et al. Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Endoscopy 2013; 45: 703-707
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Kosaka T, Endo M, Toya Y. et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Dig Endosc 2014; 26: 183-191
    CrossrefPubMedGoogle Scholar
  • 25 Oda I, Oyama T, Abe S. et al. Preliminary results of multicenter questionnaire study on long-term outcomes of curative endoscopic submucosal dissection for early gastric cancer. Dig Endosc 2014; 26: 214-219
    CrossrefPubMedGoogle Scholar
  • 26 Tanabe S, Ishido K, Higuchi K. et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center. Gastric Cancer 2014; 17: 130-136
    CrossrefPubMedGoogle Scholar
  • 27 Goto O, Fujishiro M, Kodashima S. et al. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 2009; 41: 118-122
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Tanabe S, Ishido K, Matsumoto T. et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a multicenter collaborative study. Gastric Cancer 2017; 20: 45-52
    CrossrefPubMedGoogle Scholar
  • 29 Hasuike N, Ono H, Boku N. et al. A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a): the Japan Clinical Oncology Group study (JCOG0607). Gastric Cancer 2018; 21: 114-123
    CrossrefPubMedGoogle Scholar
  • 30 Chung IK, Lee JH, Lee SH. et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 2009; 69: 1228-1235
    CrossrefPubMedGoogle Scholar
  • 31 Choi IJ, Lee NR, Kim SG. et al. Short-Term outcomes of endoscopic submucosal dissection in patients with early gastric cancer: a prospective multicenter cohort study. Gut Liver 2016; 10: 739-748
    CrossrefPubMedGoogle Scholar
  • 32 Sohn SH, Lee SH, Kim KO. et al. Therapeutic outcomes of endoscopic submucosal dissection for early gastric cancer: single-center study. Eur J Gastroenterol Hepatol 2017; 29: 61-67
    CrossrefPubMedGoogle Scholar
  • 33 Probst A, Pommer B, Golger D. et al. Endoscopic submucosal dissection in gastric neoplasia - experience from a European center. Endoscopy 2010; 42: 1037-1044
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Pimentel-Nunes P, Mourao F, Veloso N. et al. Long-term follow-up after endoscopic resection of gastric superficial neoplastic lesions in Portugal. Endoscopy 2014; 46: 933-940
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Saito I, Tsuji Y, Sakaguchi Y. et al. Complications related to gastric endoscopic submucosal dissection and their managements. Clin Endosc 2014; 47: 398-403
    CrossrefPubMedGoogle Scholar
  • 36 Suzuki H, Oda I, Abe S. et al. High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection. Gastric Cancer 2016; 19: 198-205
    CrossrefPubMedGoogle Scholar