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Papaefthymiou A, Kahaleh M, Lemmers A, Sferrazza S, Barret M, Yamamoto K, Deprez P, Marín-Gabriel JC, Tribonias G, Ouyang H, Barbaro F, Kiosov O, Seewald S, Patil G, Elkholy S, Coumaros D, Vuckovic C, Banks M, Haidry R, Mavrogenis G. Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort. Endosc Int Open 2023; 11:E673-E678. [PMID: 37744471 PMCID: PMC10513782 DOI: 10.1055/a-2105-1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/31/2023] [Indexed: 09/26/2023] Open
Abstract
Background and study aims Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD) based on the existing guidelines. This study evaluated the prevalence of UD-EGC recurrence after ESD, and potentially implicated risk factors. Patients and methods Data from 17 centers were collected retrospectively including demographics, endoscopic and pathological findings, and follow-up data from UD-EGC cases treated by ESD. Patients with incomplete resection or advanced disease were excluded. Descriptive statistics quantified variables and calculated the incidence of recurrence. Chi-square test was applied to assess any link between independent variables and relapse; significantly associated variables were inserted to a multivariable regression model. Results Seventy-one patients were eligible, with 2:1 female to male ratio and age of 65.8 ± 11.8 years. Mean lesion size was 33.5 ± 18.8 mm and the most frequent histological subtype was signet ring-cells UGC (2:1). Patients were followed-up every 5.6 ± 3.7 months with a mean surveillance period of 29.3 ± 15.3 months until data collection. Four patients (5.6%) developed local recurrence 8.8 ± 6.5 months post-ESD, with no lymph node or distal metastases been reported. Lesion size was not associated with recurrence ( P = 0.32), in contrast to lymphovascular and perineural invasion which were independently associated with local recurrence ( P = 0.006 and P < 0.001, respectively). Conclusions ESD could be considered as the initial step to manage UD-EGC, providing at least an "entire-lesion" biopsy to guide therapeutic strategy. When histology confirms absence of lymphovascular and perineural invasion, this modality could be therapeutic, providing low recurrence rates.
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Affiliation(s)
- Apostolis Papaefthymiou
- Endoscopy Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Michel Kahaleh
- Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States
| | - Arnaud Lemmers
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Sandro Sferrazza
- Department of Gastroenterology and Digestive Endoscopy, APSS Trento, Trento, Italy
| | - Maximilien Barret
- Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, France
| | - Katsumi Yamamoto
- Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Pierre Deprez
- Cliniques Universitaires St-Luc, Université Catholique de Louvain, Louvain Medical ASBL, Bruxelles, Belgium
| | | | - George Tribonias
- Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece
| | - Hong Ouyang
- Endoscopy, The People's Hospital of Linan City, hangzhou, China
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Oleksandr Kiosov
- University Clinical, Zaporizhzhia State Medical University, Zaporozhye, Ukraine
| | - Stefan Seewald
- Center for Gastroenterology, Hirlanden Clinic Zurich, Zurich, Switzerland
| | | | - Shaimaa Elkholy
- Gastroenterology Division, Internal Medicine Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Dimitri Coumaros
- Gastroenterology Department, Clinique Sainte Barbe, Strasbourg, France
| | - Clemence Vuckovic
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Matthew Banks
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Rehan Haidry
- Gastroenterology, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
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