Endoscopic Submucosal Dissection of Papillary Gastric Adenocarcinoma; Systematic Review

Abstract

This study evaluated the possibility of endoscopic submucosal dissection (ESD) for early gastric cancer with papillary adenocarcinoma (EGC-PAC). PAC, an uncommon pathologic type of stomach cancer, is classified into differentiated-type histology. However, aggressive features, including a high rate of submucosal invasion, lymphovascular invasion (LVI), and lymph node metastasis (LNM), have been reported in studies with surgical specimens. Treatment outcomes of ESD for EGC-PAC have not been precisely demonstrated. Core databases were sought for the following inclusion criteria: studies of endoscopic resection or surgery of EGC-PAC presenting the following therapeutic indicators; en bloc resection, complete resection, curative resection, recurrence, complications associated with procedures, LVI, or LNM that enabled an analysis of ESD possibility. Overall, 15 studies were included for systematic review. Frequent submucosal invasion and high LVI were noted in EGC-PAC. However, PAC was not significantly associated with LNM. Pooled en bloc resection, complete resection, and curative resection rates were 89.7% (95% confidence interval: 55.3%–98.4%), 85.3% (67.7%–94.2%), and 67% (43%–84.5%), respectively. No LNM was observed if EGC-PAC satisfied the curative resection criteria. ESD seems technically feasible, although a high LVI rate results in a lower rate of curative resection.

Clinical Outcome of Endoscopic Submucosal Dissection for Papillary Type Early Gastric Cancer: A Multicenter Study

“…In a review analyzing 15 studies, en bloc resection, complete resection, and curative resection rates were 89.7% (95% CI, 55.3% to 98.4%), 85.3% (95% CI, 67.7% to 94.2%), and 67% (95% CI, 43% to 84.5%), respectively, and there was no LN metastasis in curative resection patients. 20 In another study that analyzed the ESD results of 87 patients with papillary-type EGC, patients who underwent curative resection were followed up for a median of 58 months, and no extragastric recurrence was observed. 21 In this study, the en bloc resection and curative resection rates were 91.8% and 86.6%, respectively, and 91.1% and 93.7%, respectively, in the case of mucosal cancer.…”

Pitfalls in Endoscopic Submucosal Dissection for Early Gastric Cancer with Papillary Adenocarcinoma

“… 5 A recent systemic review including 15 studies also showed that submucosal invasion and LVI were frequent in EGC-P, and the curative resection rate was only 67.0% (95% confidence interval, 43.0% to 84.5%). 6 Accordingly, ESD should be more carefully applied for EGC-P than for EGC with other differentiated-type histologies.…”

Prediction of the Risk of Lymph Node Metastases in Early Gastric Cancer: Contrast-Enhanced Harmonic Endoscopic Ultrasonography May Help

“…11 Therefore, the characterization of lymph nodes could represent the main target of EUS during EGC staging rather than the T parameter, especially for P-EGC.Several studies performed on surgical specimens reported a worse prognosis associated with P-EGC than with other differentiated types. 2,12 However, the treatment outcomes of ESD for P-EGC have not been precisely documented. 12 A recent Korean study 13 evaluated the short-and long-term outcomes after ESD in P-EGC; the curative resection rate of P-ECG was significantly lower than those of well differentiated and moderately differentiated EGC (49.4% vs 72.5% and 93.7%, respectively), although it increased to 72.5% for mucosal (T1a) cancer.…”

“…2,12 However, the treatment outcomes of ESD for P-EGC have not been precisely documented. 12 A recent Korean study 13 evaluated the short-and long-term outcomes after ESD in P-EGC; the curative resection rate of P-ECG was significantly lower than those of well differentiated and moderately differentiated EGC (49.4% vs 72.5% and 93.7%, respectively), although it increased to 72.5% for mucosal (T1a) cancer. Despite the poor short-term outcomes, the long-term outcomes of ESD for P-EGC were favorable once…”

“…Several studies performed on surgical specimens reported a worse prognosis associated with P-EGC than with other differentiated types. 2 , 12 However, the treatment outcomes of ESD for P-EGC have not been precisely documented. 12 …”