The pathological analysis and clinical evaluation for early gastric cancer after endoscopic submucosal dissection or surgery

Abstract

Objective To analyze the pathological features of early gastric cancer （EGC）, and to evaluate the efficacy, feasibility and indications of ESD （endoscopic submucosal dissection）. Methods A total of 324 patients with EGC, who received treatment during January 2009 and December 2011 in our hospital were followed up, including 27 cases treated by ESD and 297 cases treated by radical surgery. Feasibility and safety of ESD were analyzed with chi- square test and Logistic regression based on preoperative and postoperative pathological findings. Results The overall detection rate of EGC in all gastric cancers was 14. 1% （324/2306）. The incidence of LNM （ lymph node metastasis） was 9. 6% （31/324） for all EGCs, including 4. 3% （7/164） mucosal cancers, and 15.0% （24/160） submucosal cancers. Univariate and multivariate analyses showed LNM was associated with submucosal invasion （P 〈 0. 05 ） and DI （ depth of in vasion） was closely related to age, sex, size of lesion and LNM （P 〈0. 05, respectively）. The rates of en bloc, complete and curative resection of ESD were 100% （27/27）, 77.8% （21/27） and 74. 1% （20/27）, respectively. There was no recurrence among the 27 patients treated by ESD, however, two cases underwent a second ESD due to cancer residue at horizontal margin. In accordance with guideline of ESD for EGC, 37.0% （110/297） surgical patients without LNM should have undergone ESD, while patients who showed indications for ESD but with LNM were only 5.2% （6/297）. Conclusion More than one-third of patients treated by surgery should have been cured by ESD. Effective gastroscopie biopsy, with reasonable expansion of pathological diagnostic criteria would increase the early diagnostic and curative rates of EGC. Moreover, accurate evaluation of DI helps to improve histological curative rate of EGC and to make a proper therapeutic choice between ESD and radical surgery. Key words: Early gastric cancer; Pathology, clinical; Endoscopic submucosal dissection; Surgery