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Cited 8 time in webofscience Cited 11 time in scopus
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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

Authors
Ahn, Ji YongKim, Young-, IIShin, Woon GeonYang, Hyo-JoonNam, Su YounMin, Byung-HoonJang, Jae-YoungLim, Joo HyunKim, Jie-HyunLee, Wan SikLee, Bong EunJoo, Moon KyungPark, Jae MyungLee, Hang LakGweon, Tae- GeunPark, Moo InChoi, JeongminTae, Chung HyunKim, Young-WooPark, BoramChoi, II Ju
Issue Date
May-2021
Publisher
SPRINGER
Keywords
Endoscopic submucosal dissection; Surgery; Undifferentiated histology; Stomach; Treatment outcome
Citation
Gastric Cancer, v.24, no.3, pp.731 - 743
Indexed
SCIE
SCOPUS
Journal Title
Gastric Cancer
Volume
24
Number
3
Start Page
731
End Page
743
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/51638
DOI
10.1007/s10120-020-01140-x
ISSN
1436-3291
Abstract
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-to-one 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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Joo, Moon Kyung
Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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