Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer

Early gastric cancer (EGC) with undifferentiated histology has not been generally accepted as an indication for endoscopic treatment. This study was designed to evaluate the outcomes and clinicopathological factors associated with the complete resection of undifferentiated EGC using endoscopic submucosal dissection (ESD). A retrospective analysis of prospectively collected data was performed on consecutive patients who underwent ESD. Among the 456 EGCs treated using ESD at the Seoul National University Hospital, Seoul, Korea, between April 2005 and June 2008, 60 lesions (13.2%) were diagnosed as undifferentiated gastric cancer (poorly differentiated adenocarcinoma or signet ring cell carcinoma). En bloc resection was performed in all lesions without significant complications. The size discrepancy between the pretreatment endoscopy and the resected specimen was significantly higher in undifferentiated EGCs than differentiated EGCs (p = 0.002). The complete resection rate was significantly lower for undifferentiated EGC (55%) cases than differentiated EGC cases (84.1%; p 20 mm, submucosal invasion, and presence of ulceration. During a mean observation time of 16 months, no recurrence developed in any of the patients with undifferentiated EGCs thought to be completely resected by ESD. ESD might be considered an alternative treatment modality in carefully selected cases of undifferentiated EGC.Gotoda T, 2008, GASTROINTEST ENDOSC, V67, P805, DOI 10.1016/j.gie.2008.02.008Li C, 2008, ANN SURG ONCOL, V15, P764, DOI 10.1245/s10434-007-9707-yHa TK, 2008, ANN SURG ONCOL, V15, P508, DOI 10.1245/s10434-007-9660-9Park YD, 2008, ENDOSCOPY, V40, P7, DOI 10.1055/s-2007-966750SHIN HR, 2008, J PREV MED PUB HLTH, V41, P84Ye BD, 2008, J GASTROEN HEPATOL, V23, P46, DOI 10.1111/j.1440-1746.2006.04791.xRyu KW, 2007, ANN SURG ONCOL, V14, P3428, DOI 10.1245/s10434-007-9536-zKim JH, 2007, GASTROINTEST ENDOSC, V66, P901, DOI 10.1016/j.gie.2007.06.012Kim JJ, 2007, GASTROINTEST ENDOSC, V66, P693, DOI 10.1016/j.gie.2007.04.013Takeuchi Y, 2007, GASTROINTEST ENDOSC, V66, P186, DOI 10.1016/j.gie.2007.03.1059Shimura T, 2007, J GASTROEN HEPATOL, V22, P821, DOI 10.1111/j.1440-1746.2006.04505.xIshikawa S, 2007, GASTRIC CANCER, V10, P35, DOI 10.1007/s10120-006-0407-2JANG JS, 2007, KOREAN J GASTROENTER, V49, P356Oka S, 2006, GASTROINTEST ENDOSC, V64, P877, DOI 10.1016/j.gie.2006.03.932Onozato Y, 2006, ENDOSCOPY, V38, P980, DOI 10.1055/s-2006-944809Gotoda T, 2006, J GASTROENTEROL, V41, P929, DOI 10.1007/s00535-006-1954-3ODA I, 2006, GASTRIC CANCER, V9, P262Soetikno R, 2005, J CLIN ONCOL, V23, P4490Abe N, 2004, AM J SURG, V188, P181, DOI 10.1016/j.amjsurg.2003.12.060NAKAHARA K, 2004, KURUME MED J, V51, P9HYUN DH, 2003, KOREAN J GASTROENTER, V42, P453Miyamoto S, 2002, GASTROINTEST ENDOSC, V55, P576, DOI 10.1067/mge.2002.122579Abe N, 2002, AM J SURG, V183, P168NAKAJIMA T, 2002, GASTRIC CANCER, V5, P1LEE HJ, 2002, GASTRIC CANCER, V5, P177Ohkuwa M, 2001, ENDOSCOPY, V33, P221Ono H, 2001, GUT, V48, P225GOTODA T, 2000, GASTRIC CANCER, V3, P219Tsujitani S, 1999, SURGERY, V125, P148Kojima T, 1998, GASTROINTEST ENDOSC, V48, P550Namieno T, 1998, WORLD J SURG, V22, P865*JAP GASTR CANC AS, 1998, GASTRIC CANCER, V1, P10TAKEKOSHI T, 1994, ENDOSCOPY, V26, P352TADA M, 1993, ENDOSCOPY, V25, P445