Japanese

Long Term Survival of “Extended Indication” Cases of Early Gastric Cancer Treated with ESD Akiko Takahashi 1 , Tsuneo Oyama 1 , Yoshinori Miyata 1 , Akihisa Tomori 1 , Kin-ichi Hotta 1 1Department of Gastroenterology, Saku Central Hospital, Saku, Japan Keyword: 早期胃癌 , ESD , 適応拡大病変 pp.81-89
Published Date 2008/1/25
DOI https://doi.org/10.11477/mf.1403101261
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 Background:The indication for EMR(endoscopic mucosal resection)traditionally accepted by the Japanese Gastric Cancer Association is differentiated intramucosal adenocarcinoma of less than or equal to 20 mm in diameter without ulceration. With the introduction of endoscopic submucosal dissection(ESD), an extended indication for treatment of early gastric cancer has been recently suggested.

 Purpose:The purpose of our study is to compare the outcomes of ESD for treatment of early gastric cancer following the expanded indication and that following the standard indication.

 Materials and methods:Of the 232 lesions of early gastric cancer treated with ESD at our hospital from January, 2000 to May, 2004, 187 lesions in 180 patients were followed up for over three years and were included in our analysis. These cases were divided into three groups:a standard indication group(104 patients with 108 lesions), an extended indication group for differentiated adenocarcinoma(71 patients with 74 lesions)and an extended indication group for undifferentiated adenocarcinoma(5 patients with 5 lesions). We defined the extended indication group for differentiated adenocarcinoma as(1)intramucosal cancer greater than 20 mm in diameter without ulceration, (2)intramucosal cancer less than or equal to 30 mm in diameter with ulceration, and(3)mucosal cancer with minimal submucosal invasion of 500 micrometer or less(SM1)and diameter of up to 30 mm. We also defined an extended indication group for undifferentiated adenocarcinoma as intramucosal cancer of up to 20 mm in diameter without ulceration. There were no significant differences in background among three groups. We compared with a standard indication group, the extended indication group for differentiated adenocarcinoma and the extended indication group for undifferentiated adenocarcinoma.

 Results:There was no significant difference among the three groups in complications. The complete en-bloc resection rate was 92.6%, 90.5%, 60.0%, respectively. The local recurrence rate was 0.9%, 0%, 0%, respectively. The three-year survival rate was 96.3%, 91.9%, 80.0%, respectively. And the cause-specific survival rate was 100% in the three groups.

 Conclusion:The expanded indication for ESD of early gastric cancer appears very acceptable.


Copyright © 2008, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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