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Endoscopic submucosal dissection for early gastric cancer: a large-scale follow-up study
  1. Hajime Isomoto (hajimei2002{at}yahoo.co.jp)
  1. Nagasaki University, Japan

    Abstract

    Objects: Endoscopic submucosal dissection (ESD) has the advantage over conventional endoscopic mucosa resection, permitting removal of early gastric cancer (EGC) en bloc, but long-term clinical outcomes remain unknown. We conducted a follow-up study on tumor recurrence and survival after ESD.

    Design: ESD was performed for patients with EGC that fulfilled the expanded criteria.

    Setting: The criteria for ESD were: mucosal cancer without ulcer findings irrespective of tumor size; mucosal cancer with ulcer findings ≤3 cm in diameter; and minute submucosal invasive cancer ≤3 cm in size.

    Patients: 551 patients with 589 EGC lesions were enrolled.

    Intervention: The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 6 to 89 months (median, 30 months).

    Main outcome measures: Resectability (en bloc or piecemeal resection), curability (curative or non-curative), and complications were assessed, and factors related to each were analyzed statistically. The overall and disease-free survival rates were estimated.

    Results: En bloc resection was achieved in 94.9% (559/589), and larger lesions were at higher risk of piecemeal resection. 550 of 581 lesions (94.7%) were deemed to have undergone curative resection. En bloc resection was the only significant contributor to curative ESD. Patients with non-curative resection developed local recurrence more frequently. The 5-year overall and disease-specific survival rates were 97.1% and 100%, respectively.

    Conclusion: Precise assessment of curability with successful one-piece resection may reduce tumor recurrence after ESD. The prognosis of EGC patients treated by ESD is likely to be excellent, though further longer follow-up studies are warranted.

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