Long‐term outcomes after endoscopic submucosal dissection for differentiated‐type early gastric cancer that fulfilled expanded indication criteria: A prospective cohort study
Satoki Shichijo, Noriya Uedo, Takashi Kanesaka, Takashi Ohta, Kentaro Nakagawa, Yusaku Shimamoto, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Sho Suzuki, Kenshi Matsuno, Hiroyoshi Iwagami, Shuntaro Inoue, Noriko Matsuura, Akira Maekawa, Hiroko Nakahira, Sachiko Yamamoto, Yoji Takeuchi, Koji Higashino, Ryu Ishihara, Keisuke Fukui, Yuri Ito, Hiroyuki Narahara, Shingo Ishiguro, Hiroyasu Iishi
Abstract
BACKGROUND AND AIM: Endoscopic resection for early gastric cancer (EGC) is widely performed. However, there is still a paucity of strong evidence regarding long-term outcomes after endoscopic submucosal dissection (ESD) for the expanded indication criteria of the Japanese guidelines (ver. 2010). METHODS: Endoscopic submucosal dissection was performed in patients with EGC that met the expanded indication criteria: (i) cT1a, differentiated-type EGC of 2 to 5 cm, ulcer negative or (ii) cT1a, differentiated-type EGC of ≤3 cm, ulcer positive. Patients whose pathological examination fulfilled the curative resection criteria were then enrolled in this cohort study: negative vertical margin, negative lymphovascular invasion, and (i) pT1a, differentiated-type, and ulcer negative; (ii) pT1a, differentiated-type, ≤3 cm, and ulcer positive; or (iii) pT1b1 (<500-μm submucosal invasion), differentiated-type, and ≤3 cm. Patients with only a positive horizontal margin as a noncurative factor were included for follow-up. RESULTS: From September 2003 to February 2012, a total of 356 patients underwent ESD, and 214 were enrolled in the survival analysis. One hundred twenty patients (56%) had >2 cm in diameter and ulcer-negative lesions, and 94 (44%) had ≤3 cm and ulcer-positive lesions. The vital status at 5 years after ESD was confirmed in all (100%) patients. No local or metastatic recurrence was detected; however, 26 metachronous gastric cancers developed, and 1 patient died of metachronous gastric cancer. The 5-year disease-specific and overall survival rates were 99.5% (95% confidence interval [CI], 97.2%-100%) and 93.9% (95% CI, 89.8%-96.4%), respectively. CONCLUSION: ESD for EGC that fulfills the expanded criteria is feasible and shows favorable long-term outcomes.