title: Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) has the advantage over conventional endoscopic mucosa resection, permitting removal of early gastric cancer (EGC) en bloc, but long-term clinical outcomes remain unknown. A follow-up study on tumour recurrence and survival after ESD was conducted.
  
  
  METHODS
  ESD was performed for patients with EGC that fulfilled the expanded criteria: mucosal cancer without ulcer findings irrespective of tumour size; mucosal cancer with ulcer findings <or=3 cm in diameter; and minute submucosal invasive cancer <or=3 cm in size. 551 patients with 589 EGC lesions were enrolled. The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 6-89 months (median, 30 months). The main outcome measures were resectability (en bloc or piecemeal resection), and curability (curative or non-curative). Complications were assessed, and factors related to each were analysed statistically. The overall and disease-free survival rates were estimated.
  
  
  RESULTS
  En bloc resection was achieved in 94.9% (559/589), and larger lesions were at higher risk of piecemeal resection. 550 of 581 lesions (94.7%) were deemed to have undergone curative resection. En bloc resection was the only significant contributor to curative ESD. Patients with non-curative resection developed local recurrence more frequently. The 5-year overall and disease-specific survival rates were 97.1% and 100%, respectively.
  
  
  CONCLUSIONS
  Precise assessment of curability with successful one-piece resection may reduce tumour recurrence after ESD. The prognosis of EGC patients treated by ESD is likely to be excellent, though further longer follow-up studies are warranted.
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. hajimei2002@yahoo.co.jp
authors.forename: H
authors.initials: H
authors.lastname: Isomoto
authors.forename: S
authors.initials: S
authors.lastname: Shikuwa
authors.forename: N
authors.initials: N
authors.lastname: Yamaguchi
authors.forename: E
authors.initials: E
authors.lastname: Fukuda
authors.forename: K
authors.initials: K
authors.lastname: Ikeda
authors.forename: H
authors.initials: H
authors.lastname: Nishiyama
authors.forename: K
authors.initials: K
authors.lastname: Ohnita
authors.forename: Y
authors.initials: Y
authors.lastname: Mizuta
authors.forename: J
authors.initials: J
authors.lastname: Shiozawa
authors.forename: S
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; D055088:Early Detection of Cancer; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome