Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

Abstract

Background The 2010 Japanese Gastric Cancer Association guidelines for the treatment of submucosal invasive gastric cancer (SM-GC) specify size 30 mm or less, differentiated-dominant histology, lack of vessel involvement, and submucosal invasion of less than 500 lm (SM1) as expanded criteria for curative endoscopic resection. Our purpose in this study was to confirm the validity of the expanded indications for curative endoscopic submucosal dissection (ESD) of SM-GC. Methods The study subjects were 173 patients with SM-GC resected by ESD at Hiroshima University Hospital between April 2002 and September 2010, including 99 patients for whom 3-plus years' follow-up information was available. Post-ESD outcomes were compared between cases of SM1-GC that met the expanded ESD criteria, those that did not, and SM2-GC cases.Results Complete resection was achieved for 93.2% of the SM1-GCs that met the expanded criteria. There was neither metastasis to lymph nodes or other organs nor local recurrence among the SM1-GCs. Disease-specific survival did not differ significantly between patients that were simply followed up after ESD and those that were treated by additional surgical resection. Conclusions Our outcome data support the clinical validity of ESD without additional surgical resection for SM1-GCs that meet the expanded criteria.

Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis

“…Further studies are needed to evaluate the usefulness of EUS for diagnosing fibrosis. Thus far, we have reported that submucosal invasion of B1,000 lm, tumor diameter B30 mm, differentiated type as the dominant histological type, and absence of vessel involvement may allow expansion of the criteria for determining whether endoscopic resection can be considered curative for submucosal invasive gastric cancer [32,33]. New methods for recognizing ulceration and submucosal cancers preoperatively will be important.…”

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

“…If the diagnostic histopathological findings confirm a submucosal carcinoma (T1b) after ER, surgical resection that includes systematic lymphadenectomy has to be performed, because database findings indicate lymph node involvement in up to 20 % of these patients. The earlier established ''extended criteria'' for ER can only be used in the context of studies, since these need expertise, most likely present in high-volume centers [21][22][23][24]. ER of early gastric cancer should be performed as a complete enbloc resection, which allows a complete histological evaluation of the lateral and basal margins.…”

Risk factors and management of positive horizontal margin in early gastric cancer resected by en bloc endoscopic submucosal dissection

“…Endoscopic submucosal dissection (ESD) is widely accepted for early gastric cancer (EGC), and it can be performed regardless of tumor size, location, or fibrosis [1][2][3][4][5][6][7][8][9][10][11]. According to the Japanese Gastric Cancer Association (JGCA), [12] the absolute indication for curative ESD are well-or moderately differentiated intramucosal adenocarcinoma B2 cm in diameter without ulceration and absence of lymph node (LN) metastasis and lymphatic vessel invasion.…”