Endoscopy 2009; 41(2): 118-122
DOI: 10.1055/s-0028-1119452
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria

O.  Goto1 , M.  Fujishiro1 , S.  Kodashima1 , S.  Ono1 , M.  Omata1
  • 1Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Further Information

Publication History

submitted 2 February 2008

accepted after revision 5 November 2008

Publication Date:
12 February 2009 (online)

Background and study aims: Endoscopic submucosal dissection (ESD) is a novel, promising endoscopic technique for gastrointestinal neoplasms. We aimed to elucidate the feasibility of ESD as curative treatment for intestinal-type early gastric cancer (EGC) potentially without lymph-node metastases.

Patients and methods: For the short-term analysis, 276 consecutive, intestinal-type EGCs, which fulfilled the criteria for node-negative EGC in 231 patients who had undergone ESD from January 2000 to March 2007, were retrospectively investigated. For the long-term analysis, 212 lesions checked by endoscopy later than 1 year or recurrence within 1 year after ESD were assessed for local recurrence, and 208 patients followed for over 1 year or to death within 1 year after ESD were assessed for metastases and survival. All lesions/patients were divided into three groups: intramucosal cancer without ulcerative findings (M-Ul[−]); intramucosal cancer with ulcerative findings, ≤ 3 cm (M-Ul[+]); and slight invasive cancer into submucosa (< 500 µm), ≤ 3 cm (SM1).

Results: En bloc and complete resection rates were 96.7 % and 91.7 %, respectively. During a median follow-up of 36 months (range 2 – 93 months), two local recurrences occurred (0.9 %), which were detected at 2 and 6 months after ESD, respectively. During a median follow-up of 38 months (range 6 – 97 months), the 5-year overall and disease-specific survival rates were 96.2 % and 100 %, respectively, with neither lymph node nor other-organ metastasis; one patient died due to other disease 6 months after ESD. No disease-related death occurred. No significant differences were found between the groups in short- and long-term analyses.

Conclusions: The prognostic analyses demonstrated the validity of the criteria of node-negative intestinal-type EGC as curability criteria for ESD. ESD can be proposed as an alternative method to gastrectomy for the treatment of these EGCs.

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M. FujishiroMD, PhD 

Department of Gastroenterology
Graduate school of Medicine
University of Tokyo

7-3-1, Hongo
Bunkyo-ku
Tokyo
Japan

Fax: +81-3-58008806

Email: mtfujish-kkr@umin.ac.jp