Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including undifferentiated-type tumors: a criteria-based analysis

Lee, Sunpyo; Choi, Kee Don; Han, Minkyu; Na, Hee Kyong; Ahn, Ji Yong; Jung, Kee Wook; Lee, Jeong Hoon; Kim, Do Hoon; Song, Ho June; Lee, Gin Hyug; Yook, Jeong Hwan; Kim, Byung Sik; Jung, Hwoon Yong

doi:10.1007/s10120-017-0772-z

Cited by 67 publications

(53 citation statements)

References 19 publications

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“…112,113 However, retrospective studies reported a low incidence of extragastric metastasis during follow-up and high five-year survival rates of 95.0%-98.6% among patients who underwent endoscopic resection for undifferentiated type adenocarcinoma with mucosal invasion, no ulcer and ≤2 cm in size. 100,[114][115][116][117][118] Studies also reported no significant difference in long-term outcomes between endoscopic resection and surgical resection for the aforementioned lesions. 95,100,103,118 Thus, endoscopic resection may be recommended for undifferentiated type gastric adenocarcinoma with mucosal invasion, no ulcer and ≤2 cm in size.…”

Section: Statement G5mentioning

confidence: 99%

“…[99][100][101] Additionally, studies reported no significant difference between the five-year survival rate of surgical resection and endoscopic resection (92.0%-97.2% vs. 93.3%-96.4%), indicating that endoscopic resection is considered curative for the aforementioned lesions with no requirement of further treatment. 95,100,[102][103][104][105][106][107][108][109] Surgical resection is the standard treatment for clinically suspected submucosal invasive gastric cancer in preoperative evaluation. However, studies analyzing pathologic results of patients who underwent gastrectomy due to preoperatively suspected submucosal invasion reported that 28.8%-43.0% of these lesions could have been treated with endoscopic resection.…”

Section: Statement G3: We Recommend Endoscopic Resection For Early Gamentioning

confidence: 99%

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Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Section: Statement G5mentioning

confidence: 99%

Section: Statement G3: We Recommend Endoscopic Resection For Early Gamentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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“…In fact, the former did have higher risk of local recurrence and metachronous lesions than those undergoing surgery . However, results of studies showed that ESD had a similar 5‐year OS and 5‐year CSS to surgery irrespective of the absolute or expanded indication for endoscopic resection, location (stomach or esophagogastric junction), or age of the patients …”

Section: Surveillance Strategy For Egcmentioning

confidence: 99%

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Zhang

Gao

et al. 2019

J of Digest Diseases

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With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow-up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level-C1 EGC. For patients with a level-C2 EGC, close follow-up is suggested for low-risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes. K E Y W O R D Scurative resection, early gastric cancer, eCura system, endoscopy, gastric neoplasms, surveillance

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“…Curative endoscopic surgery alone was not rarely reported to cure localized primary tumor, especially among early gastric cancer, colorectal neoplasia, and glottic cancer, as it could achieve radical resection of the localized primary tumor in early stage cancer without regional lymph nodes metastasis. Nasopharyngeal carcinoma (NPC) is common head and neck cancer in China and Southeast Asia, with a reported annual incidence of 50 per 100 000 population .…”

Section: Introductionmentioning

confidence: 99%

Techniques of endoscopic nasopharyngectomy for localized stage I nasopharyngeal carcinoma

et al. 2020

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Background Endoscopic surgery was widely applied as radical treatment for early cancer. We aimed to demonstrate the details of endoscopic nasopharyngectomy (ENPG) for nasopharyngeal carcinoma (NPC). Methods Before operation, we first defined the gross tumor volume (GTV) and surgical tumor volume (STV) for resection. STV was defined as gross tumor volume plus an additional 0.5‐1.0 cm peripheral mucosa margin and a 2‐3 mm basal margin on the surface skull base. The surgeon was required to follow this planned STV to remove the tumor. Results En bloc resection was achieved in the endoscopic operation, and multiple margin biopsies were proved pathologically negative. Comparison between preoperative and postoperative magnetic resonance imaging revealed that actual STV (aSTV) had contained the STV completely. Mostly, no death, recurrence, or distant metastasis was observed in this case during the 3‐year follow‐up. Conclusions Techniques of ENPG for treating newly diagnosed localized stage I NPC patients were feasible.

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Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including undifferentiated-type tumors: a criteria-based analysis

Abstract: ESD may be an alternative treatment option to surgery for EGCs meeting expanded indications, including undifferentiated-type tumors.

Cited by 67 publications

References 19 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Techniques of endoscopic nasopharyngectomy for localized stage I nasopharyngeal carcinoma

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