Endoscopic submucosal dissection has the advantage over conventional endoscopic mucosa resection, permitting removal of early gastric cancer en bloc, but long-term clinical outcomes remain unknown.
Dr Isomoto and colleagues from Japan conducted a follow-up study on tumor recurrence and survival after endoscopic submucosal dissection.
Endoscopic submucosal dissection was performed for patients with early gastric cancer that fulfilled the expanded criteria.
The expected criteria includes 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.
The team enrolled 551 patients with 589 early gastric cancer lesions.
|En bloc resection was achieved in 95%|
The patients underwent endoscopic submucosal dissection, and then received periodic endoscopic follow-up and metastatic surveys for 6 to 89 months.
The main outcome measures were resectability, and curability.
The team assessed complications, and factors related to each were analyzed statistically.
The overall and disease-free survival rates were estimated.
En bloc resection was achieved in 95%, and larger lesions were at higher risk of piecemeal resection.
The researchers deemed 95% of lesions to have undergone curative resection.
En bloc resection was the only significant contributor to curative endoscopic submucosal dissection.
Patients with non-curative resection developed local recurrence more frequently.
The research team noted that the 5-year overall and disease-specific survival rates were 97% and 100%, respectively.
Dr Isomoto’s team concludes, “Precise assessment of curability with successful one-piece resection may reduce tumor recurrence after endoscopic submucosal dissection.”
“The prognosis of early gastric cancer patients treated by endoscopic submucosal dissection is likely to be excellent, though further longer follow-up studies are warranted.”