Clinical Characteristics of Gastric Cancers That Are Difficult to Treat by Endoscopic Submucosal Dissection and Measures Against Them Maasa Sasabe 1 , Keiichiro Nakajo 1 , Atsushi Inaba 1 , Hironori Sunakawa 1 , Tomonori Yano 1 1Division of Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan Keyword: JCOG0607 , 早期胃癌 , ESD , 治療困難因子 pp.53-60
Published Date 2021/1/25
DOI https://doi.org/10.11477/mf.1403202227
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 In the JCOG0607 clinical trial on expanded indications for endoscopic submucosal dissection(ESD), patients with ulcer(UL)-negative tumors >2cm or UL-positive tumors ≤3cm in size showed equivalent survival to those who underwent surgery with lymph node dissection. Thus, the clinical guidelines published by the Japanese Gastric Cancer Association in 2018 were expanded for ESD indications to include T1a intestinal-type gastric adenocarcinoma with UL-negative tumors >2cm or UL-positive tumors ≤3cm in size. These expanded indications can be problematic, resulting in issues like longer procedure time(≤120min), perforation, and/or piecemeal resection. Using the data from JCOG0607 to explore the factors related to technical difficulty of performing ESD for early gastric cancer, we found an association with UL-negative tumors >3cm in size, tumors located in the upper- or middle-third portion of the stomach, and patients ≤60 years old. Innovative methods, such as the use of traction apparatus and improvements in cutting devices, have gradually resolved the technical difficulty of ESD. Therefore, continuous efforts are necessary to develop new methods and devices for safer execution of ESD.

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