Short-Term Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study

Abstract

Background/aims: Endoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC) that has demonstrated a minimal risk of lymph node metastasis in retrospective studies. We sought to prospectively evaluate the short-term outcomes of ESD treatment in EGCs.

Methods: A prospective multicenter cohort study of neoplasms 3 cm or less in diameter at endoscopic size evaluation was performed in 12 Korean ESD study grouprelated university hospitals and the National Cancer Center. Resected specimens were evaluated by the central pathologic review board.

Results: A patient cohort (n=712) with a total of 737 EGCs was analyzed. The margin-free en bloc resection rate was 97.3%, and curative resection of 640 lesions (86.8%) was achieved. Lower curative resection rates were associated with lesions 2 to 3 cm in size prior to ESD compared with lesions 2 cm or less in size (78.6% vs 88.1%, respectively, p=0.009). Significant factors associated with noncurative resection were moderately or poorly differentiated histological type, posterior wall tumor location, tumor size larger than 3 cm, ulceration, and submucosal invasion. Delayed bleeding occurred in 49 patients (6.9%), and 12 patients (1.7%) exhibited perforations.

Conclusions: ESD is an effective treatment with a high curative resection rate for EGCs that meets relatively conservative pre-ESD indications. Long-term survival outcomes should be evaluated in followup studies.

Keywords: Endoscopy; Outcome assess; Prospective studies; Stomach neoplasms; gastrointestinal.

Fig. 1

Flow chart of participant selection. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection.

Fig. 2

Pathological and clinical outcomes after endoscopic submucosal dissection (ESD). Complete resection was defined when an differentiated type mucosal early gastric cancer (EGC) without lymphovascular invasion was resected with tumor free margins. LVI, lymphovascular invasion; PD, poorly differentiated adenocarcinoma; Sm, submucosa; M, mucosa; APC, argon plasma coagulation.