Applicability of endoscopic submucosal dissection for patients with early gastric cancer beyond the expanded indication for endoscopic submucosal dissection

Jeong Ho Song, Sejin Lee, Sung Hyun Park, Anastasios Kottikias, Aleisa Abdulmohsen, Nasser Alrashidi, Minah Cho, Yoo Min Kim, Hyoung Il Kim, Woo Jin Hyung

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Endoscopic submucosal dissection (ESD) application for patients with tumors beyond the expanded indication for ESD is inconclusive. This study aimed to identify the preoperative clinical features that can be curatively treated with ESD in patients with early gastric cancer (EGC) beyond the indication of ESD. Methods: From 2006 to 2016, 673 patients who underwent gastrectomy for EGC beyond the expanded indication for ESD based on preoperative assessments were retrospectively reviewed. We identified tumors curatively resected by ESD based on the postoperative pathologic findings. We also analyzed the clinical and pre-treatment features to determine the risk factors associated with curative resection of ESD. Results: 39% of the patients (263/673) who had undergone gastrectomy had tumors of endoscopic curability A or B (eCuraA/B) that could be treated by ESD alone. In multivariate analysis, tumor size ≤ 10 mm (OR 0.240; 95% CI = 0.12–0.46), no ulceration (OR 0.500; 95% CI = 0.29–0.87), differentiated histology (OR 0.599; 95% CI = 0.43–0.84), and location in the distal two-thirds of the stomach (OR 0.499; 95% CI = 0.28–0.88) in pre-treatment assessment were identified as independent predictors of eCuraA/B. Considering the risk factors, 63.6% (7/11)/61.3% (19/31) of patients with a differentiated/undifferentiated tumor size ≤ 10 mm located in distal two-third of the stomach without ulceration were deemed as eCuraA/B. Conclusions: This study suggests that patients with EGC indicated for surgery can be treated by ESD by adding tumor locations in the indication for ESD. Thus, ESD can be applied for patients with a tumor size ≤ 10 mm located in the lower/middle stomach without ulceration.

Original languageEnglish
JournalSurgical endoscopy
DOIs
Publication statusAccepted/In press - 2022

Bibliographical note

Funding Information:
Dr. Woo Jin Hyung reports receiving research grants from the Medtronic (4-2017-0940) and GC Pharma (4-2018-0306), is the Chief Executive Officer of Hutom, and holds its stock. He provided consultancy services to Ethicon and Verb Surgical outside of the submitted work. Drs. Jeong Ho Song, Sejin Lee, Sung Hyun Park, Anastasios Kottikias, Aleisa Abdulmohsen, Nasser Alrashidi, Minah Cho, Yoo Min Kim, and Hyoung-Il Kim have no conflicts of interest or financial ties to disclose.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

All Science Journal Classification (ASJC) codes

  • Surgery

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