Sa1644 Outcomes and Long Term Prognosis of Endoscopic Submucosal Dissection for Early Gastric Cancer

Abstract

Outcomes and Long Term Prognosis of Endoscopic Submucosal Dissection for Early Gastric Cancer Ken Ohnita*, Hajime Isomoto, Kayoko Matsushima, Yuko Akazawa, Naoyuki Yamaguchi, Hitoshi Nishiyama, Eiichiro Fukuda, Fuminao Takeshima, Saburo Shikuwa, Kazuhiko Nakao Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan; Internal Medicine, Sankokai Miyazaki Hospital, Isahaya, Japan Backgrounds: Endoscopic submucosal dissection (ESD) yields high rate of curative resection of early gastric cancer (EGC). However, little information is available on the long term outcomes of ESD in a large number of patients. Patients and method: A total of 1332 EGCs in 1209 consecutive patients were treated by ESD from January 2001 to December 2010. The indication criteria (group A) were defined as differentiated -type mucosal cancer without ulceration 2 cm in diameter. Expanded indication criteria (group B) were defined as follows; differentiated -type mucosal cancer without ulceration irrespective of tumor size, differentiated -type mucosal cancer with ulceration 3 cm in diameter, differentiated -type minute ( 500 m from the muscularis mucosae, sm1) submucosal invasive cancer 3 cm in size, and undifferentiated-type mucosal cancer without ulceration 2 cm in diameter with no lymphaticvascular involvement. Out of indication (group C) were defined as except for group A and B. The early outcomes (perforation and bleeding rate and curability) were assessed in 1209 patients. Resections were considered curative when a tumor was excised by en bloc and was within the indication or expanded indication criteria with tumor-free lateral and vertical margins and no lymphovascular invasion. Long-term outcomes were assessed in 319 patients for over 5-year follow-up. Overall survival rates among the three groups were compared. We compared the overall survival rates in different age groups. Results: Short-term outcomes were as follows; The 617 (46.3%) lesions were defined as group A , 507 (38.1%) lesions were defined as group B, and the 208 (15.6%) lesions were defined as group C. Curative resection rate were 96.6% (596/617) in group A and 91.5% (464/507) in group B. Total perforation rate was 2.9% (39/1332), which was higher in group B than in group A (4.3% [22/507] versus 1.8% [11/617], p 0.05). Total bleeding rate was 2.0% (26/1332), which was significantly higher in group C than in group A (4.8% [10/208] versus 1.1% [7/617], p 0.01) and in group B (4.8% [10/208] versus 1.8% [9/507], p 0.05). In analysis of long term outcomes, median term of observation was 66 months (1106 months). In the 53 patients out of group C, 26 patients had additional surgery. Of the 266 patients with group A or group B, 41 patients died of nongastric cancer disease. Of the 53 patients with group C, 11 patients died (one patient died of gastric cancer). The 5-year survival rates in three groups were not significantly different. However, the 5-year survival rates in the patients over 80 years old (59.2%) were lower than the younger age-group (under 60 years old; 88.4%, sixties; 93.5%, seventies; 82.7%) (p 0.01). Conclusions: Expanded indication of ESD for early gastric cancer is appropriate, but it is necessary to consider the basal disease in elder patients.