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Multicenter Study
. 2018 Jul 15;12(4):402-410.
doi: 10.5009/gnl17414.

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

Sang Gyun Kim  1 , Chan Mi Park  2 , Na Rae Lee  2 , Jiyoung Kim  2 , Da Hyun Lyu  2 , Seung-Hee Park  2 , Il Ju Choi  3 , Wan Sik Lee  4 , Seun Ja Park  5 , Jae Jun Kim  6 , Ji Hyun Kim  7 , Chul-Hyun Lim  8 , Joo Young Cho  9 , Gwang Ha Kim  10 , Yong Chan Lee  11 , Hwoon-Yong Jung  12 , Jun Haeng Lee  6 , Hoon Jai Chun  13 , Sang-Yong Seol  7
Affiliations
Multicenter Study

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

Sang Gyun Kim et al. Gut Liver. .

Abstract

Background/aims: Endoscopic submucosal dissection (ESD) has been regarded as a curative treatment for early gastric cancer (EGC) in indicated cases. The aim of this study was to evaluate the nationwide long-term clinical outcomes of ESD for EGC in Korea.

Methods: A prospective multicenter cohort study was performed to evaluate the long-term efficacy of ESD for EGC within pre-defined indications at 12 institutes in Korea. The cases that met the expanded criteria upon pathological review after ESD were followed for 5 years. The primary outcome was 5-year disease specific free survival.

Results: Six hundred ninety-seven patients with 722 EGCs treated with ESD were prospectively enrolled and followed for 5 years. Complete resection was achieved in 81.3% of the cases, and curative resection was achieved in 86.1%. During the 5-year follow-up, the overall survival rate was 96.6%, and the disease specific free survival rate was 90.6%. Local recurrence developed in 0.9%, and metachronous tumor development occurred in 7.8%; both conditions were treated by endoscopic or surgical treatment. Distant metastasis developed in 0.5% during follow-up.

Conclusions: ESD showed excellent long-term clinical outcomes and can be accepted as a curative treatment for patients with EGC who meet the expanded criteria in final pathology studies.

Keywords: Endoscopic mucosal dissection; Stomach neoplasms; Survival.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Enrollment of patients. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection. *In 31 patients, viotation of enrollment is overlapped.
Fig. 2
Fig. 2
Survival rates of all patients.
Fig. 3
Fig. 3
Survival rates according to curative resection.
Fig. 4
Fig. 4
Recurrence rates according to curative resection. (A) All recurrences of gastric cancer, including local, distant, and metachronous tumor. (B) Distant metastasis. (C) Local recurrence of index cancer. (D) Metachronous recurrence.
Fig. 5
Fig. 5
Survival rates for absolute and expanded criteria.
See this image and copyright information in PMC

Comment in

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