Appropriate indications for endoscopic submucosal dissection of early gastric cancer according to tumor size and histologic type

Background

Endoscopic submucosal dissection (ESD) is increasingly being performed for early gastric cancers (EGCs) that are larger than 2 cm and those that are not intestinal-type (IT) cancers by Lauren's classification. The technical feasibility of ESD for these EGCs has not been fully evaluated.

Objective

To identify appropriate expanded indications for ESD of EGC.

Design and Setting

A retrospective analysis of prospectively collected data was performed on consecutive patients who underwent ESD at a single tertiary center.

Patients and Methods

In total, 487 EGCs in 461 patients treated by ESD were classified by size and histologic type: IT EGCs 2 cm or less (257 lesions in 235 patients), IT EGCs larger than 2 cm (172 lesions in 168 patients), and non-IT EGCs (58 lesions in 58 patients).

Main Outcome Measurements

Curative resections were assessed among the 3 groups, and logistic regression analysis was used to analyze factors related to curative resection.

Results

The rates of curative resection significantly decreased from IT EGCs 2 cm or less (88.7%) to IT EGCs larger than 2 cm (73.3%) to non-IT EGCs (37.9%). Tumor size (>3 cm), ulceration, histologic type (non-IT), and piecemeal resection were independently unfavorable factors in curative resection.

Limitations

Small sample size and short-term duration of follow-up study.

Conclusions

ESD with curative intent is technically most feasible for nonulcerative and IT EGCs smaller than 3 cm.

Abbreviations: APC, argon plasma coagulation, DT, diffuse type, EGC, early gastric cancer, ESD, endoscopic submucosal dissection, IT, intestinal type, MT, mixed type