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Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis
Chang Seok Bang1, Gwang Ho Baik1, In Soo Shin1
1Chang Seok Bang, Gwang Ho Baik, Jing Bong Kim, Ki Tae Suk, Jai Hoon Yoon, Yeon Soo Kim, Dong Joon Kim, Woon Geon Shin, Kyung Ho Kim, Hak Yang Kim, Hyun Lim, Ho Seok Kang, Jong Hyeok Kim, Jin Bae Kim, Sung Won Jung, Sea Hyub Kae, Hyun Joo Jang, Min Ho Choi, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 200-704, South Korea.
Aim:
To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) with undifferentiated-type histology.
Methods:
A systematic literature review was conducted using the core databases. Complete resection, curative resection, en bloc resection, recurrence and adverse event rate were extracted and analyzed. A random effect model was applied. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated using a funnel plot, the trim and fill method, Egger's test, and a rank correlation test.
Results:
Fourteen retrospective studies between 2009 and 2014 were identified (972 EGC lesions with undifferentiated-type histology). The total en bloc and complete resection rates were estimated as 92.1% (95%CI: 87.4%-95.2%) and 77.5% (95%CI: 69.3%-84%), respectively. The total curative resection rate was 61.4% (95%CI: 44.5%-75.9%). The overall recurrence rate was 7.6% (95%CI: 3.4%-16%). Limited to histologically diagnosed expanded-criteria lesions, the en bloc and complete resection rates were 91.2% and 85.6%, respectively. The curative resection rate was 79.8%.
Conclusion:
In this analysis, ESD is a technically feasible treatment modality for EGC with undifferentiated-type histology. Long-term studies are needed to confirm these therapeutic outcomes.
