Appropriate indications for endoscopic submucosal dissection of early gastric cancer according to tumor size and histologic type

Abstract

Background: Endoscopic submucosal dissection (ESD) is increasingly being performed for early gastric cancers (EGCs) that are larger than 2 cm and those that are not intestinal-type (IT) cancers by Lauren's classification. The technical feasibility of ESD for these EGCs has not been fully evaluated.

Objective: To identify appropriate expanded indications for ESD of EGC.

Design and setting: A retrospective analysis of prospectively collected data was performed on consecutive patients who underwent ESD at a single tertiary center.

Patients and methods: In total, 487 EGCs in 461 patients treated by ESD were classified by size and histologic type: IT EGCs 2 cm or less (257 lesions in 235 patients), IT EGCs larger than 2 cm (172 lesions in 168 patients), and non-IT EGCs (58 lesions in 58 patients).

Main outcome measurements: Curative resections were assessed among the 3 groups, and logistic regression analysis was used to analyze factors related to curative resection.

Results: The rates of curative resection significantly decreased from IT EGCs 2 cm or less (88.7%) to IT EGCs larger than 2 cm (73.3%) to non-IT EGCs (37.9%). Tumor size (>3 cm), ulceration, histologic type (non-IT), and piecemeal resection were independently unfavorable factors in curative resection.

Limitations: Small sample size and short-term duration of follow-up study.

Conclusions: ESD with curative intent is technically most feasible for nonulcerative and IT EGCs smaller than 3 cm.