Endoscopy 2019; 51(04): S41
DOI: 10.1055/s-0039-1681290
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ESD stomach 1 Club A
Georg Thieme Verlag KG Stuttgart · New York

PROGNOSIS OF ENDOSCOPIC RESECTION IN PATIENT WITH EARLY GASTRIC CANCER WITH UNDIFFERENTIATED TYPE HISTOLOGY

YW Shin
1   Inha University Hospital, Incheon, Korea, Republic of
2   Gastroenterology, Inha University Hospital, Incheon, Korea, Republic of
,
SW Park
3   Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea, Republic of
,
BW Bang
4   Indiana University School of Medicine, Incheon, Korea, Republic of
,
KS Kwon
1   Inha University Hospital, Incheon, Korea, Republic of
,
H Kim
2   Gastroenterology, Inha University Hospital, Incheon, Korea, Republic of
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
18. März 2019 (online)

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    Aims:

    In case of early gastric cancer (EGC) with undifferentiated type histology, which did not meet the extended criteria after endoscopic submucosal dissection (ESD), addition of surgical treatment should be recommended. In clinical practice, however, there are many patients who refuse or cannot be performed surgery due to old age and comorbidities. The aim of this study was to investigate the rate of recurrence and survival in those patients.

    Methods:

    A total of 77 patients who had undergone ESD due to EGC with undifferentiated type histology from January 2005 to December 2015 were analysed retrospectively. Fifty six patients of them who did not receive additional surgery were subdivided into four groups, as with submucosal or lymphovascular invasion, diameter above 2 cm, positive lateral margin and curative resection according to risk of recurrence.

    Results:

    The mean follow up period was 47.3 (12 – 117) months. Seven of 56 patients (12.5%) had local recurrence or lymph node metastasis during that period. The recurrence rates of the patients with submucosal or lymphovascular invasion, diameter above 2 cm, and positive lateral margin were 25% (5/20), 14.3% (1/6) and 0% (0/5) respectively. On the other hand, Among 24 patients who achieved curative resection without risk factors as above, no recurrence occurred. All of 7 patients with recurrence underwent surgery and 1 of them died of advanced gastric cancer. The mean duration of recurrence after ESD was 27.1 (12 – 69) months.

    Conclusions:

    Surgical resection is the definite curative treatment in undifferentiated EGC with risk factors, such as submucosal invasion, lymphovascular invasion, larger than 2 cm in diameter after endoscopic resection. But in undifferentiated EGC without such risk factors after endoscopic resection, follow up or secondary endoscopic resection can be an alternative modality even in lateral margin positive patients.


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