title: Long-term outcome of early gastric cancer after endoscopic submucosal dissection: expanded indication is comparable to absolute indication.
abstract: BACKGROUND
  Endoscopic submucosal dissection has become widely used for early gastric cancer with an expanded indication, although there is no strong consensus. We aimed to compare the clinical and long-term oncological outcome after endoscopic submucosal dissection according to indication.
  
  
  METHODS
  Retrospective review of 1152 patients with 1175 lesions who had undergone endoscopic submucosal dissection for early gastric cancer at tertiary educational hospital in Korea, between March 2005 and November 2011. Of these, 366 and 565 lesions were included in the absolute and expanded indication groups, respectively.
  
  
  RESULTS
  En bloc resection rates were not significantly different between the absolute and expanded indication groups. The complete resection rate was higher in the absolute indication group versus the expanded indication group (94.8% vs. 89.9%, respectively; P=0.008). In the expanded indication group, complete resection rate was higher in the differentiated versus undifferentiated tumour subgroups (92.9% vs. 78.4%, respectively; P<0.001). Recurrence rates were 7.7% in the absolute indication group vs. 9.3% in the expanded indication group (P=0.524). Disease-free survival was not significantly different between the two indication groups (P=0.634).
  
  
  CONCLUSIONS
  Endoscopic submucosal dissection for early gastric cancer with expanded indication is a feasible approach to disease management. Periodic endoscopic follow-up is necessary to detect cancer recurrence.
authors: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Chan Hyuk
authors: CH
authors: Park
authors: Suji
authors: S
authors: Shin
authors: Jun Chul
authors: JC
authors: Park
authors: Sung Kwan
authors: SK
authors: Shin
authors: Sang Kil
authors: SK
authors: Lee
authors: Yong Chan
authors: YC
authors: Lee
authors: Hyuk
authors: H
authors: Lee
mesh_terms: D004210:Dissection / Q000379:methods; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D056910:Republic of Korea; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Indication; Recurrence; Survival