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Cited 2 time in webofscience Cited 3 time in scopus
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Clinical outcomes of endoscopic resection for undifferentiated intramucosal early gastric cancer larger than 2 cm

Authors
Yang, Hyo-JoonNam, Su YounMin, Byung-HoonAhn, Ji YongJang, Jae-YoungKim, JungKim, Jie-HyunLee, Wan-SikLee, Bong EunJoo, Moon KyungPark, Jae MyungShin, Woon GeonLee, Hang LakGweon, Tae-GeunPark, Moo InChoi, JeongminTae, Chung HyunKim, Young-IlChoi, Il Ju
Issue Date
Mar-2021
Publisher
Springer Verlag
Keywords
Stomach neoplasms; Undifferentiated-type histology; Endoscopic mucosal resection; Treatment outcome; Lymph node metastasis
Citation
Gastric Cancer, v.24, no.2, pp.435 - 444
Indexed
SCIE
SCOPUS
Journal Title
Gastric Cancer
Volume
24
Number
2
Start Page
435
End Page
444
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/33947
DOI
10.1007/s10120-020-01115-y
ISSN
1436-3291
Abstract
Background This study investigated the long-term clinical outcomes of endoscopic resection (ER) for undifferentiated-type (UD) early gastric cancer (EGC), with tumor size > 2 cm as the only non-curative factor. Methods From among 1123 patients who underwent ER for UD EGC at 18 tertiary hospitals in Korea between 2005 and 2014, we identified 216 patients with UD intramucosal EGC > 2 cm, which was completely resected, with negative resection margins, and absence of ulceration and lymphovascular invasion. The patients were divided into the additional surgery (n = 40) or observation (n = 176) groups, according to post-ER management and were followed up for a median duration of 59 months for recurrence and 90 months for overall survival. Results Lymph node (LN) or distant metastasis or cancer-related mortality was not observed in the surgery group. In the observation group, two (1.1%) patients developed LN or distant metastasis with a 5-year cumulative risk of 0.7%, and one (0.6%) patient died of gastric cancer. The 5- and 8-year overall survival rates were 94.1% and 89.9%, respectively, in the observation group and 100.0% and 95.2%, respectively, in the surgery group (log-rank P = 0.159). Cox regression analysis did not reveal an association between the observation group and increased mortality. Conclusion The risk of LN or distant metastasis was not negligible, but as low as 1% for patients undergoing non-curative ER for UD EGC, with tumor size > 2 cm as the only non-curative factor. Close observation may be an alternative to surgery, especially for older patients or those with poor physical status.
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Joo, Moon Kyung
Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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