Clinical outcomes of endoscopic resection for undifferentiated intramucosal early gastric cancer larger than 2 cm

Hyo Joon Yang, Su Youn Nam, Byung Hoon Min, Ji Yong Ahn, Jae Young Jang, Jung Kim, Jie Hyun Kim, Wan Sik Lee, Bong Eun Lee, Moon Kyung Joo, Jae Myung Park, Woon Geon Shin, Hang Lak Lee, Tae Geun Gweon, Moo In Park, Jeongmin Choi, Chung Hyun Tae, Young Il Kim, Il Ju Choi

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3 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)435-444
Number of pages10
JournalGastric Cancer
Issue number2
Publication statusPublished - 2021 Mar

Bibliographical note

Funding Information:
This work was supported by the Korean College of Helicobacter and Upper Gastrointestinal Research (Woon Geon Shin 2017 and Hyo-Joon Yang 2018) and the National Research Foundation of Korea (2020R1G1A1010927). Acknowledgements

Funding Information:
The authors also acknowledge the valuable contribution of Boram Park, PhD, Biostatistics Collaboration Team, Research Core Center, Research Institute, National Cancer Center, Goyang, Korea, who performed statistical analyses of data.

Publisher Copyright:
© 2020, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research


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