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The superficial elevated and depressed lesion type is an independent factor associated with non-curative endoscopic submucosal dissection for early gastric cancer

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Abstract

Background

The expanded criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) have led to an increase in the number of EGC patients who receive curative treatment involving endoscopic techniques. Identifying the factors that are associated with treatment outcomes would be helpful in the application of ESD for EGC.

Methods

Potential factors associated with incomplete ESD and with non-curative ESD were investigated using a multiple logistic regression model in EGC patients who consecutively underwent ESD according to the expanded criteria.

Results

A total of 363 patients with 398 EGC lesions were enrolled. The rates of complete ESD and curative ESD were 96.2 % (383/398) and 85.7 % (341/398), respectively. No significant factors associated with incomplete ESD were identified. In contrast, a tumor size >20 mm [odds ratio (OR) 3.31; 95 % confidence interval (CI) 1.74–6.29], the superficial elevated and depressed type (0-IIa + IIc or IIc + IIa) (OR 4.37; 95 % CI 1.88–9.88), and the undifferentiated type (OR 5.93; 95 % CI 1.65–19.41) were identified as independent factors associated with non-curative ESD. The superficial elevated and depressed type in particular was found to be highly related to submucosal and lymphovascular invasion. The rate of non-curative ESD in cases of this macroscopic type occurring together with a tumor size >20 mm was 58.3 %, and the adjusted OR was 16.48 (95 % CI 4.69–62.09).

Conclusion

The results suggest that the superficial elevated and depressed type is an independent factor associated with non-curative ESD and that the risk of non-curative ESD is increased when this macroscopic type is present along with a large tumor size.

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Acknowledgments

The authors thank Dr. Kaori Sugiura, Department of Gastroenterology, Kurashiki Central Hospital, for reviewing the data from the enrolled patients.

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Authors and Affiliations

  1. Department of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University Hospital, Kobe, Japan

    Yoshiko Ohara

  2. Department of Hepatology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-029, Japan

    Nobuyuki Toshikuni

  3. Department of Gastroenterology, Kurashiki Central Hospital, Kurashiki, Japan

    Kazuhiro Matsueda, Hirokazu Mouri & Hiroshi Yamamoto

Authors
  1. Yoshiko Ohara
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  2. Nobuyuki Toshikuni
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  3. Kazuhiro Matsueda
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  4. Hirokazu Mouri
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  5. Hiroshi Yamamoto
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Corresponding author

Correspondence to Nobuyuki Toshikuni.

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Disclosures

Drs. Yoshiko Ohara, Nobuyuki Toshikuni, Kazuhiro Matsueda, Hirokazu Mouri, and Hiroshi Yamamoto have no conflicts of interest or financial ties to disclose.

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Ohara, Y., Toshikuni, N., Matsueda, K. et al. The superficial elevated and depressed lesion type is an independent factor associated with non-curative endoscopic submucosal dissection for early gastric cancer. Surg Endosc 30, 4880–4888 (2016). https://doi.org/10.1007/s00464-016-4825-x

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  • DOI: https://doi.org/10.1007/s00464-016-4825-x

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