Endoscopic Submucosal Dissection Criteria for Differentiated-type Early Gastric Cancer Are Applicable to Mixed-type...

Area of Science:

• Gastroenterology
• Oncology
• Surgical Endoscopy

Background:

• Mixed-type differentiated predominant early gastric cancer (MD-EGC) lacks sufficient evidence for endoscopic treatment guidelines based on differentiated-type early gastric cancer (EGC) criteria.
• Endoscopic submucosal dissection (ESD) is a key treatment for EGC, but its efficacy in MD-EGC requires evaluation.

Purpose of the Study:

• To evaluate the efficacy and outcomes of endoscopic submucosal dissection (ESD) for mixed-type differentiated predominant early gastric cancer (MD-EGC).
• To compare the clinicopathological characteristics, resection outcomes, and recurrence/survival rates of MD-EGC with pure differentiated-type EGC (PD-EGC) treated with ESD.

Main Methods:

• Retrospective review of patients with EGC treated with ESD between January 2015 and June 2021.
• Comparison of clinical and pathological data, including invasion rates, resection success, and patient survival, between MD-EGC and PD-EGC groups.

Main Results:

• MD-EGC demonstrated significantly higher rates of submucosal invasion (37.5% vs. 13.7%) and lymphatic invasion (10.4% vs. 0.4%) compared to PD-EGC.
• Complete resection (70.8% vs. 92.5%) and curative resection (54.2% vs. 87.4%) rates were lower for MD-EGC.
• MD-EGC was an independent risk factor for noncurative resection (OR 4.26), but no significant differences in recurrence or survival rates were observed when curative resection was achieved.

Conclusions:

• MD-EGC exhibits greater malignancy and a lower endoscopic curative resection rate compared to PD-EGC.
• Despite challenges, patients with MD-EGC achieving curative resection through ESD have a favorable long-term prognosis.
• These findings suggest ESD can be effective for MD-EGC when curative resection is successful, though careful patient selection is crucial.