Comparison between endoscopic submucosal resection and surgery for the curative resection of undifferentiated-type early gastric cancer within expanded indications: a nationwide multi-center study

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

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: Endoscopic submucosal dissection (ESD) for undifferentiated early gastric cancer (UD EGC) has debate due to the risk of lymph node metastasis. We investigated the outcomes of ESD compared to those of surgery for the UD EGC within expanded indication. Methods: We reviewed 971 UD EGC patients performed ESD across 18 hospitals in Korea and 1812 patients who underwent surgical resection in two hospitals between February 2005 and May 2015. Of these cases, we enrolled a curative resected ESD group of 328 patients and surgery group of 383 cases within an expanded indication. Overall outcomes and one-to-one propensity score-matched (218 ESD group vs 218 surgery group cases) outcomes for these two groups were analyzed. Results: Over the 75.6 month median follow-up period for the 711 enrolled cases, recurrences occurred in 22 patients (6.7%) in the ESD group but not in the surgery group. Overall survival (OS) was higher in the surgery group (p = 0.0316) in all cases, but there was no significant difference after propensity score matching (p = 0.069). According to the histologic type in propensity score matching, the OS of signet ring cell carcinoma and poorly differentiated carcinoma patients did not differ between the ESD and surgery groups (p = 0.1189 and p = 0.3087, respectively). In the surgery group involving expanded criteria, lymph node metastasis was found in six cases (1.56%). Conclusions: Although ESD shows comparable outcomes to surgery for the UD EGC within expanded indications, appropriate patient selection is needed for the ESD due to the possibility of lymph node metastasis.

Original languageEnglish
Pages (from-to)731-743
Number of pages13
JournalGastric Cancer
Volume24
Issue number3
DOIs
StatePublished - 2021 May
Externally publishedYes

Keywords

  • Endoscopic submucosal dissection
  • Stomach
  • Surgery
  • Treatment outcome
  • Undifferentiated histology

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