Endoscopic Submucosal Dissection for Early Gastric Cancer Exceeding Expanded Criteria-Long-Term Outcomes from the...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Endoscopic submucosal dissection (ESD) is standard for early gastric cancer (EGC) within guideline (GC) or expanded criteria (EC).
• Surgical resection is typically recommended for EGC lesions exceeding EC.
• A subset of patients with EGC outside EC (OI) do not undergo surgery.

Purpose of the Study:

• To investigate the long-term outcomes of patients undergoing ESD for EGC outside the EC (OI).
• To compare outcomes between patients treated within GC, EC, and OI criteria.

Main Methods:

• Analysis of patients from the prospective German ESD registry who underwent ESD for EGC.
• Stratification of patients into three groups: GC, EC, and OI based on histopathological features.
• Evaluation of patient and procedure characteristics, and follow-up data over 48 months.

Main Results:

• 54 lesions (27.7%) were classified as OI.
• R0 resection rates were significantly lower in the OI group (55.6%) compared to GC (94.4%) and EC (84.3%) groups.
• 72% of OI patients did not undergo additional surgery, and showed no significant difference in overall survival compared to EC patients after a mean 37-month follow-up.

Conclusions:

• ESD for EGC lesions outside EC (OI) can lead to favorable long-term survival without additional surgery.
• Individualized treatment decisions are crucial, considering patient comorbidities and surgical risks.
• ESD may be a viable alternative to surgery for selected OI patients.