Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort

Kwak, Dong Shin; Ye, Min; Lee, Jun Haeng; Kang, Soo Hoon; Jang, Seung Hoon; Lee, Hyuk; Kim, Jae J.; Kim, Kyoung‐Mee; Sohn, Tae Sung

doi:10.5009/gnl17247

Cited by 10 publications

(5 citation statements)

References 38 publications

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“…To address this problem, many researchers have reviewed surgical data retrospectively and have thereby generated indication criteria for ESD that included very low or negative risk of lymph node metastasis. Previous studies have also reported a rate of lymph node metastasis below 1% for UD EGC within the expanded indication criteria in surgical cases and recommended ESD for lesions of less than 1 cm in size [9,[28][29][30][31]. In our current study, however, we observed a 1.56% rate of lymph node metastasis in our expanded indication UD EGC series, and the smallest of these was a 4 mm PDA with lamina propria invasion.…”

Section: Discussioncontrasting

confidence: 76%

Comparison between endoscopic submucosal resection and surgery for the curative resection of undifferentiated-type early gastric cancer within expanded indications: a nationwide multi-center study

et al. 2020

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Background and aims Endoscopic submucosal dissection (ESD) for undifferentiated early gastric cancer (UD EGC) has debate due to the risk of lymph node metastasis. We investigated the outcomes of ESD compared to those of surgery for the UD EGC within expanded indication. Methods We reviewed 971 UD EGC patients performed ESD across 18 hospitals in Korea and 1812 patients who underwent surgical resection in two hospitals between February 2005 and May 2015. Of these cases, we enrolled a curative resected ESD group of 328 patients and surgery group of 383 cases within an expanded indication. Overall outcomes and one-toone propensity score-matched (218 ESD group vs 218 surgery group cases) outcomes for these two groups were analyzed. Results Over the 75.6 month median follow-up period for the 711 enrolled cases, recurrences occurred in 22 patients (6.7%) in the ESD group but not in the surgery group. Overall survival (OS) was higher in the surgery group (p = 0.0316) in all cases, but there was no significant difference after propensity score matching (p = 0.069). According to the histologic type in propensity score matching, the OS of signet ring cell carcinoma and poorly differentiated carcinoma patients did not differ between the ESD and surgery groups (p = 0.1189 and p = 0.3087, respectively). In the surgery group involving expanded criteria, lymph node metastasis was found in six cases (1.56%). Conclusions Although ESD shows comparable outcomes to surgery for the UD EGC within expanded indications, appropriate patient selection is needed for the ESD due to the possibility of lymph node metastasis.

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Section: Discussioncontrasting

confidence: 76%

Comparison between endoscopic submucosal resection and surgery for the curative resection of undifferentiated-type early gastric cancer within expanded indications: a nationwide multi-center study

et al. 2020

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“…For undifferentiated-type carcinoma, such a study using pre-ESD tumor size is not available, but there is a simulation study using gastrectomy cases comparing the endoscopic values and pathologic values. In this study, the cases that met the curative resection criteria had smaller endoscopic tumor size than the non-curative group (1.08 cm vs. 1.30 cm) [23]. For the studies using post-ESD pathologic size, the curative resection rates were 50%, 70%, 79%, and 84% when the mean tumor sizes were 1.7 cm, 1.5 cm, 1.1 cm, and 0.8 cm, respectively [13,15,24,25].…”

Section: Discrepancy Of the Risk Factors Between Pre-esd Vs Post-esdmentioning

confidence: 99%

Risk Factors for Lymph Node Metastasis in Undifferentiated-Type Gastric Carcinoma

Kook

2019

Clin Endosc

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Undifferentiated-type carcinoma has a high incidence of lymph node metastasis. The independent risk factors for lymph node metastasis in undifferentiated-type carcinoma are invasion depth, tumor size, lymphovascular invasion, and presence of ulcer. In the cases that meet the curative resection criteria, no lymph node metastasis was observed in the Japanese studies, but some metastases were observed in Korean studies. After performing curative endoscopic submucosal dissection, the survival rate is similar to that of gastrectomy. The discrepancy between endoscopy and pathology is high in undifferentiated-type carcinoma. The tumor size in endoscopy is a significant risk factor for non-curative resection, and when the tumor size is small, the non-curative resection rate is significantly reduced. Lymphovascular invasion can be assessed in pathologic examination and D2-40 stain is helpful. The presence of ulcer should be determined by pathology, but ulcer’s omission in pathology report makes the analysis difficult. Undifferentiatedtype carcinomas with differentiated-type components show higher lymph node metastasis rate than that of pure undifferentiatedtype carcinomas. The lymph node metastasis rate of signet ring cell type is lower than that of other undifferentiated-type carcinomas and is similar to differentiated-type carcinomas. The application of these additional histologic findings may improve the indication of endoscopic submucosal dissection.

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“…The seven included reports, involving five from South Korea[ 10 - 14 ] and two from Japan[ 15 , 16 ] investigated 653 cases of UD SRC EGC. The enrolled trials are described in detail in Tables 1 and 2 .…”

Section: Resultsmentioning

confidence: 99%

Endoscopic submucosal dissection for early signet ring cell gastric cancer: A systematic review and meta-analysis

Weng¹,

Sun²,

Cai³

et al. 2022

WJCC

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BACKGROUND The use of endoscopic submucosal dissection (ESD) for treating early signet ring cell carcinoma (SRC) is controversial due to the risk of lymph node metastasis. AIM To carry out a meta-analysis to evaluate ESD for therapeutic efficacy and safety in early signet ring cell gastric cancer. METHODS The PubMed, Web of Science, Cochrane Library, and EMBASE databases were used to search for relevant studies evaluating the therapeutic efficacy and safety of ESD in SRC. The rates of recurrence, complete resection, incomplete resection, curative resection, en bloc resection, and adverse events were extracted and analyzed. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated by the Egger’s test. Institutional review board approval and written consent were not needed for this report. RESULTS This meta-analysis enrolled seven studies with 653 participants undergoing ESD treatment for early SRC. The overall recurrence rate was 0.010 [95% confidence interval (CI): 0.000-0.040, Z = 1.422, P = 0.155]. The total lymphovascular invasion rate was 0.038 (95%CI: 0.007-0.088, Z = 3.026, P = 0.002). The total en bloc resection rate was estimated at 0.984 (95%CI: 0.925-1.000, Z = 19.463, P = 0.000). The total complete and incomplete resection rates were estimated at 0.785 (95%CI: 0.596-0.928, Z = 9.789, P = 0.000) and 0.188 (95%CI: 0.016-0.468, Z = 2.531, P = 0.011), respectively. The total procedure-associated gastric hemorrhage and perforation rates were estimated at 0.026 (95%CI: 0.005-0.061, Z = 3.006 P = 0.003) and 0.004 (95%CI: 0.000-0.028, Z = 0.938, P = 0.348), respectively. The curative resection, vertical margin invasion, and lateral margin invasion rates were 72.1% (145/341), 2.3% (8/348), and 34.45% (41/119), respectively. CONCLUSION ESD constitutes a promising therapeutic approach for early undifferentiated SRC gastric cancer. However, further improvements are required for increasing its treatment efficacy and reducing adverse outcomes.

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Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort

Cited by 10 publications

References 38 publications

Comparison between endoscopic submucosal resection and surgery for the curative resection of undifferentiated-type early gastric cancer within expanded indications: a nationwide multi-center study

Comparison between endoscopic submucosal resection and surgery for the curative resection of undifferentiated-type early gastric cancer within expanded indications: a nationwide multi-center study

Risk Factors for Lymph Node Metastasis in Undifferentiated-Type Gastric Carcinoma

Endoscopic submucosal dissection for early signet ring cell gastric cancer: A systematic review and meta-analysis

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