Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Bang, Chang Seok; Baik, Gwang Ho; Is, Shin; Jb, Kim; Kt, Suk; Jh, Yoon; Ys, Kim; Dj, Kim; Wg, Shin; Kh, Kim; Hy, Kim; Lim, Hyeon‐Sook; Kang, Hyun-Cheol; Sw, Jung; Sh, Kae; Jang, Hyejeong; Mh, Choi

doi:10.3748/wjg.v21.i19.6032

Cited by 43 publications

(35 citation statements)

References 49 publications

(92 reference statements)

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“…The complete resection rate with endoscopic resection was 85.0%, which was similar to the complete resection rate for differentiated EGCs in previous studies [1114]. Furthermore, this result was higher than that for undifferentiated EGCs that ranged from 60% to >80% in recent studies [212223]. Advances in endoscopic techniques and devices have increased the immediate clinical outcomes of patients with early GCLS.…”

Section: Discussionsupporting

confidence: 80%

A Single-Center Experience of Endoscopic Resection for Early Gastric Cancer with Lymphoid Stroma

et al. 2018

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PurposeThis study aimed to evaluate immediate outcomes and clinical courses of patients with early gastric carcinoma with lymphoid stroma (GCLS) who underwent endoscopic resection.Materials and MethodsWe retrospectively reviewed the medical records of 40 patients (mean age, 56.9 years; 90.0% male) who underwent endoscopic resection and were pathologically diagnosed with GCLS confined to the mucosa or to the submucosa between March 1998 and December 2017.ResultsForty GCLS lesions in 40 patients were treated using endoscopic resection. Only 4 (10%) patients received diagnosis of GCLS before endoscopic resection. Fourteen (35.0%) lesions were intramucosal cancers and 26 (65.0%) exhibited submucosal invasion. En bloc resection (97.5%) was achieved for all lesions except one, with no significant complications. The complete resection rate was 85.0% (34 of 40 lesions). After endoscopic resection, 17 patients were referred for surgery and underwent gastrectomy with lymph node (LN) dissection because of deep submucosal invasion (n=16) and misclassification as undifferentiated cancer (n=1). No LN metastasis was determined in the specimens obtained during surgery. During a mean follow-up period of 49.7 months for 23 patients without surgical treatment, no regional LN enlargements, distant metastases, or gastric cancer-related deaths were found, although 1 metachronous lesion (undifferentiated adenocarcinoma, follow-up duration: 7 months) was observed.ConclusionsIn patients with early GCLS, endoscopic resection is technically feasible and has favorable clinical outcomes. Therefore, endoscopic resection might represent an alternative treatment modality in patients with early GCLS with a low likelihood of LN metastasis.

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Section: Discussionsupporting

confidence: 80%

A Single-Center Experience of Endoscopic Resection for Early Gastric Cancer with Lymphoid Stroma

et al. 2018

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“…The therapeutic outcomes of ER of EGC with undifferentiated-type histology have previously been presented using a meta-analysis of small studies [ 7 ]. Although these data suggested the technical feasibility of ER of these lesions, the follow-up durations of the included studies were relatively short, and most studies did not present therapeutic outcomes divided by PDC and SRC.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis

et al. 2017

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Background/AimsTo assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology. MethodsCases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed. ResultsFrom 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years). ConclusionsER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.

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“…Authors previously reported therapeutic outcomes of ESD for EGC-UH using pooled meta-analysis of crude outcomes of each study. [13] The common effect size will be extracted from each study using method previously described (pooled meta-analysis of crude outcomes) [13] , and we will also perform sensitivity and meta-regression analyses using the modifiers identified during the systematic review to confirm the robustness of the main result and to identify the reason of heterogeneity. If paucity data exist for endoscopic resection of EGC with PAC, the rate of LNM will be described and retrospective application of ESD criteria for surgically resected specimen will be performed, whenever possible.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic submucosal dissection of papillary adenocarcinoma of stomach; protocol for a systematic review and meta-analysis

Bang¹,

Choi²,

Lee

et al. 2018

Medicine

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Background:Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who has a negligible risk of lymph node metastasis. Papillary adenocarcinoma (PAC) of stomach is a rare histologic variant of gastric cancer and categorized into EGC with differentiated-histology. However, aggressive features such as higher rate of lymphovascular invasion (LVI) or submucosal invasion have been reported, whereas comparable lymph node metastasis (LNM) rate to the lesions meeting the current ESD criteria also has been reported. This study aimed to evaluate the feasibility of ESD for EGC with PAC.Methods:We will search the core databases (MEDLINE (through PubMed), the Cochrane Library, and Embase) from their inception to December 2018 by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have EGC with PAC, Intervention: ESD or surgery, Comparison: none, Outcome: at least one among the rate of complete resection, curative resection, en bloc resection, recurrence, procedure-related adverse event, LVI or LNM that enabled an evaluation of the feasibility of ESD. All types of study design with full text will be sought and included. The risk of bias will be assessed using the ROBINS-I tool. Descriptive data synthesis is planned, and quantitative synthesis will be used if the included studies are sufficiently homogenous. Publication bias will be assessed with quantitative analyses if more than 10 articles are enrolled.Results:The results will provide evidence for efficacy and safety of ESD for EGC with PAC.Conclusion:This study will provide evidence of ESD for EGC with PAC.

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Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Abstract: In this analysis, ESD is a technically feasible treatment modality for EGC with undifferentiated-type histology. Long-term studies are needed to confirm these therapeutic outcomes.

Cited by 43 publications

References 49 publications

A Single-Center Experience of Endoscopic Resection for Early Gastric Cancer with Lymphoid Stroma

A Single-Center Experience of Endoscopic Resection for Early Gastric Cancer with Lymphoid Stroma

Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis

Endoscopic submucosal dissection of papillary adenocarcinoma of stomach; protocol for a systematic review and meta-analysis

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