title: Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) of undifferentiated-type early gastric cancer (UD-EGC) is technically feasible; however, the long-term clinical outcomes of the procedure have not yet been fully investigated. The aim of our study was to elucidate long-term outcomes of ESD for UD-EGC.
  
  
  METHODS
  Between September 2003 and October 2009, a total of 153 patients were diagnosed endoscopically as having UD-EGC fulfilling the expanded criteria for ESD. After informed consent was obtained, 101 patients were selected to undergo ESD and 52 to undergo surgical operation. We assessed the clinical outcomes of ESD in 101 consecutive patients with 103 UD-EGC lesions who were undergoing ESD for the first time. The overall mortality and disease-free survival rates after ESD were evaluated as the long-term outcomes.
  
  
  RESULTS
  The rates of en bloc and curative resection were 99.0% (102/103) and 82.5% (85/103), respectively. We encountered one patient with nodal metastasis detected by computed tomography before diagnostic ESD, although curative resection of the primary lesion was achieved based on routine histological examination. Among the 78 patients without a past history of malignancy within the previous 5 years in whom curative resection of the primary lesion was achieved, no cases of local recurrence or distant metastasis were observed during follow-up; however, 1 synchronous and 2 metachronous lesions were detected in 2 patients (2.6%) after primary ESD. Thus, estimated over a median follow-up period of 40.0 months (range 19-92 months) and 36.0 months (range 9-92 months), the 3-and 5-year overall mortality rates were 1.9% and 3.9%, respectively, and the 3-and 5-year overall disease-free survival rates were both 96.7%.
  
  
  CONCLUSIONS
  Although our single-center retrospective study may be considered to be only preliminary, our data indicate that ESD for UD-EGC may yield good long-term outcomes.
authors.affiliation: Division of Endoscopy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Okada
authors.forename: J
authors.initials: J
authors.lastname: Fujisaki
authors.forename: T
authors.initials: T
authors.lastname: Yoshida
authors.forename: H
authors.initials: H
authors.lastname: Ishikawa
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authors.initials: T
authors.lastname: Suganuma
authors.forename: A
authors.initials: A
authors.lastname: Kasuga
authors.forename: M
authors.initials: M
authors.lastname: Omae
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authors.initials: M
authors.lastname: Kubota
authors.forename: A
authors.initials: A
authors.lastname: Ishiyama
authors.forename: T
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authors.lastname: Hirasawa
authors.forename: A
authors.initials: A
authors.lastname: Chino
authors.forename: M
authors.initials: M
authors.lastname: Inamori
authors.forename: Y
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: N
authors.initials: N
authors.lastname: Yamamoto
authors.forename: T
authors.initials: T
authors.lastname: Tsuchida
authors.forename: Y
authors.initials: Y
authors.lastname: Tamegai
authors.forename: A
authors.initials: A
authors.lastname: Nakajima
authors.forename: E
authors.initials: E
authors.lastname: Hoshino
authors.forename: M
authors.initials: M
authors.lastname: Igarashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome