Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria

Background and study alms: Endoscopic submucosal dissection (ESD) is a novel, promising endoscopic technique for gastrointestinal neoplasms. We aimed to elucidate the feasibility of ESD as curative treatment for intestinal-type early gastric cancer (EGC) potentially without lymph-node metastases. Patients and methods: For the short-term analysis, 276 consecutive, intestinal-type EGCs, which fulfilled the criteria for node-negative EGC in 231 patients who had undergone ESD from January 2000 to March 2007, were retrospectively investigated. For the long-term analysis, 212 lesions checked by endoscopy later than 1 year or recurrence within 1 year after ESD were assessed for local recurrence, and 208 patients followed for over 1 year or to death within 1 year after ESD were assessed for metastases and survival. All lesions/patients were divided into three groups: intramucosal cancer without ulcerative findings (M-U1[-]): intramucosal cancer with ulcerative findings, <= 3cm (M-U1[+]); and slight invasive cancer into submucosa (<500 mu m), <= 3 cm (SM1). Results: En bloc and complete resection rates were 96.7% and 91.7%, respectively. During a median follow-up of 36 months (range 2-93 months), two local recurrences occurred (0.9%), which were detected at 2 and 6 months after ESD, respectively. During a median follow-up of 38 months (range 6-97 months), the 5-year overall and disease-specific survival rates were 96.2% and 100%, respectively, with neither lymph node nor other-organ metastasis; one patient died due to other disease 6 months after ESD. No disease-related death occurred. No significant differences were found between the groups in short- and long-term analyses. Conclusions: The prognostic analyses demonstrated the validity of the criteria of node-negative intestinal-type EGC as curability criteria for ESD. ESD can be proposed as an alternative method to gastrectomy for the treatment of these EGCs.