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Excellent prognosis for patients with early gastric cancer treated with endoscopic submucosal dissection

Early gastric cancer (EGC), that is, gastric cancer confined to the mucosa or submucosa, is prevalent in Japan. Endoscopic mucosal resection (EMR) is widely accepted as standard treatment for EGC, but it is not reliable for larger lesions or for EGC with ulcer findings. In preliminary studies, endoscopic submucosal dissection (ESD) has been proposed to be superior to EMR for removing larger or ulcerated EGC in an en bloc manner. In this large follow-up study, including 551 patients with EGC, Isomoto et al demonstrate excellent prognosis following ESD, with 5-year overall and disease-specific survival rates of 97.1% and 100%, respectively (see fig). They were able to perform en bloc resection in the majority of cases (94.9%), and 94.7% of the lesions were deemed to have undergone curative resection based on the histopathological evaluation. During follow-up, a small, but significant, number of patients developed local recurrence, as well as metachronous gastric cancers. From this study it can be concluded that the prognosis after ESD for EGC seems to be excellent, but continued surveillance for recurrent tumours is necessary. See page 331.

Overall survival curve of patients with early gastric cancer treated by endoscopic submucosal dissection.

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