title: Endoscopic submucosal dissection for undifferentiated-type early gastric cancer: do we have enough data to support this?
abstract: Although endoscopic submucosal dissection (ESD) is now accepted for treatment of early gastric cancers (EGC) with negligible risk of lymph node (LN) metastasis, ESD for intramucosal undifferentiated type EGC without ulceration and with diameter ≤ 2 cm is regarded as an investigational treatment according to the Japanese gastric cancer treatment guidelines. This consideration was largely based on the analysis of surgically resected EGCs that contained undifferentiated type EGCs; however, results from several institutes showed some discrepancies in sample size and incidence of LN metastasis. Recently, some reports about the safety and efficacy of ESD for undifferentiated type EGC meeting the expanded criteria have been published. Nonetheless, only limited data are available regarding long-term outcomes of ESD for EGC with undifferentiated histology so far. At the same time, endoscopists cannot ignore the patients' desire to guarantee quality of life after the relatively non-invasive endoscopic treatment when compared to conventional surgery. To satisfy the needs of patients and provide solid evidence to support ESD for undifferentiated EGC, we need more delicate tools to predict undetected LN metastasis and more data that can reveal predictive factors for LN metastasis.
authors.affiliation: Choong Nam Shim, Sang Kil Lee, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Choong Nam
authors.initials: CN
authors.lastname: Shim
authors.affiliation: Choong Nam Shim, Sang Kil Lee, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000465:Algorithms; D002454:Cell Differentiation; D002986:Clinical Trials as Topic; D004210:Dissection; D004724:Endoscopy / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007564:Japan; D008207:Lymphatic Metastasis; D009362:Neoplasm Metastasis; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012307:Risk Factors; D018401:Sample Size; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Early gastric cancer; Endoscopic submucosal dissection; Indications; Undifferentiated histology
references.citation: Gastric Cancer. 2009;12(3):148-52
references.pmid: 19890694
references.citation: Gastric Cancer. 2012 Sep;15 Suppl 1:S3-18
references.pmid: 21837458
references.citation: Endoscopy. 2009 Jun;41(6):498-503
references.pmid: 19533552
references.citation: Ann Surg Oncol. 2012 May;19(5):1541-50
references.pmid: 22048632
references.citation: Gastroenterol Res Pract. 2013;2013:217695
references.pmid: 23401676
references.citation: Surg Oncol. 2012 Jun;21(2):119-23
references.pmid: 21256735
references.citation: Cancer. 2002 Jun 1;94(11):2867-73
references.pmid: 12115374
references.citation: Am J Surg. 1988 Mar;155(3):476-80
references.pmid: 3344913
references.citation: Gastric Cancer. 2006;9(2):93-8
references.pmid: 16767364
references.citation: Gastric Cancer. 2013 Jan;16(1):1-27
references.pmid: 22729699
references.citation: Endoscopy. 2002 Dec;34(12):973-8
references.pmid: 12471541
references.citation: Surg Endosc. 2010 Mar;24(3):509-16
references.pmid: 19585066
references.citation: Gastrointest Endosc. 1988 May-Jun;34(3):264-9
references.pmid: 3391382
references.citation: J Dig Dis. 2008 Nov;9(4):213-8
references.pmid: 18959593
references.citation: Ann Surg Oncol. 2008 Mar;15(3):764-9
references.pmid: 18043971
references.citation: Am J Surg. 2004 Aug;188(2):181-4
references.pmid: 15249247
references.citation: Endoscopy. 1993 Sep;25(7):445-50
references.pmid: 8261986
references.citation: Gastric Cancer. 2011 Jun;14(2):101-12
references.pmid: 21573743
references.citation: Surg Endosc. 2009 Dec;23(12):2650-5
references.pmid: 19357916
references.citation: Hum Pathol. 2006 Sep;37(9):1193-9
references.pmid: 16938525
references.citation: J Korean Med Sci. 1991 Mar;6(1):7-14
references.pmid: 1888453
references.citation: Gastric Cancer. 2011 Jun;14(2):113-23
references.pmid: 21573742
references.citation: Hepatogastroenterology. 1998 Sep-Oct;45(23):1907-11
references.pmid: 9840174
references.citation: World J Gastroenterol. 2012 Sep 7;18(33):4578-84
references.pmid: 22969232
references.citation: Digestion. 2010;81(1):35-42
references.pmid: 20029207
references.citation: Endoscopy. 2010 Dec;42(12):1037-44
references.pmid: 20972955
references.citation: Gastric Cancer. 2007;10(1):1-11
references.pmid: 17334711
references.citation: Endoscopy. 2011 Aug;43(8):664-70
references.pmid: 21623560
references.citation: Hum Pathol. 1998 Jul;29(7):702-9
references.pmid: 9670827
references.citation: Surg Endosc. 2011 Mar;25(3):841-8
references.pmid: 20734082
references.citation: Gastrointest Endosc. 2009 Mar;69(3 Pt 2):631-6
references.pmid: 19251003
references.citation: Gastrointest Endosc. 2004 Feb;59(2):288-95
references.pmid: 14745410
references.citation: Gut. 1997 Aug;41(2):142-50
references.pmid: 9301490
references.citation: Gut. 2009 Mar;58(3):331-6
references.pmid: 19001058
references.citation: Gastrointest Endosc. 1998 Nov;48(5):470-6
references.pmid: 9831834
references.citation: BMJ. 1993 Sep 4;307(6904):591-6
references.pmid: 8401015
references.citation: Hepatogastroenterology. 2012 Mar-Apr;59(114):607-11
references.pmid: 21940373
references.citation: Cancer. 1989 Nov 15;64(10):2053-62
references.pmid: 2680049
references.citation: Gastrointest Endosc. 1999 Oct;50(4):560-3
references.pmid: 10502182
references.citation: Endoscopy. 2009 Feb;41(2):118-22
references.pmid: 19214889
references.citation: Surg Endosc. 2013 Oct;27(10):3690-5
references.pmid: 23588711
references.citation: World J Gastroenterol. 2008 Jul 14;14(26):4222-6
references.pmid: 18636670
references.citation: J Natl Compr Canc Netw. 2013 May 1;11(5):531-46
references.pmid: 23667204
references.citation: Endoscopy. 2012 Feb;44(2):122-7
references.pmid: 22271022
references.citation: J Gastroenterol Hepatol. 2008 Jan;23(1):46-50
references.pmid: 18171341
references.citation: Dig Dis Sci. 2013 Aug;58(8):2329-36
references.pmid: 23589139
references.citation: Eur J Gastroenterol Hepatol. 2009 Oct;21(10):1132-5
references.pmid: 19369881
references.citation: World J Gastroenterol. 2013 May 28;19(20):3096-107
references.pmid: 23716990
references.citation: Surg Obes Relat Dis. 2008 Sep-Oct;4(5):660-3
references.pmid: 18794028
references.citation: Endoscopy. 2012 Oct;44(10):949-52
references.pmid: 22987215
references.citation: Dig Endosc. 2011 May;23 Suppl 1:58-71
references.pmid: 21535204
references.citation: Gastric Cancer. 2012 Sep;15 Suppl 1:S48-59
references.pmid: 22262403
references.citation: Gastric Cancer. 2010 Nov;13(4):267-70
references.pmid: 21128064
references.citation: Surg Endosc. 2011 Sep;25(9):3087-93
references.pmid: 21487870
references.citation: Digestion. 2012;85(2):111-5
references.pmid: 22269290
references.citation: Dig Dis Sci. 2010 May;55(5):1376-80
references.pmid: 19657738
references.citation: Gastrointest Endosc. 2009 Apr;69(4):e1-9
references.pmid: 19327466
references.citation: Ann Surg Oncol. 2002 Jan-Feb;9(1):13-9
references.pmid: 11829425
references.citation: Digestion. 2009;80(3):173-81
references.pmid: 19776581
references.citation: Eur J Surg Oncol. 2011 Aug;37(8):655-61
references.pmid: 21636243
references.citation: Ann Surg Oncol. 2013 Feb;20(2):522-32
references.pmid: 22941161
references.citation: Histopathology. 2004 May;44(5):437-44
references.pmid: 15139991
references.citation: Br J Surg. 2010 Jun;97(6):868-71
references.pmid: 20301163
references.citation: J Surg Oncol. 2013 Feb;107(2):124-9
references.pmid: 22991272
references.citation: J Gastroenterol Hepatol. 2011 May;26(5):884-7
references.pmid: 21198830
references.citation: Ann Oncol. 2010 May;21 Suppl 5:v50-4
references.pmid: 20555102
references.citation: Endoscopy. 2009 May;41(5):427-32
references.pmid: 19418397
references.citation: Gastrointest Endosc. 2011 Dec;74(6):1259-67
references.pmid: 22136775
references.citation: J Gastroenterol Hepatol. 2010 Oct;25(10):1636-41
references.pmid: 20880172
references.citation: Gastric Cancer. 2008;11(3):134-48
references.pmid: 18825308
references.citation: Virchows Arch. 2008 May;452(5):525-34
references.pmid: 18266006
references.citation: Oncol Rep. 2012 Sep;28(3):841-7
references.pmid: 22752002
references.citation: Gastrointest Endosc. 1998 Nov;48(5):550-4; discussion 554-5
references.pmid: 9831855
references.citation: World J Gastroenterol. 2011 Jun 7;17(21):2597-601
references.pmid: 21677826
references.citation: Gastrointest Endosc. 2012 Dec;76(6):1124-32
references.pmid: 23025977
references.citation: Surg Endosc. 2011 Jun;25(6):1985-93
references.pmid: 21136092
references.citation: Gastric Cancer. 2006;9(2):51-66
references.pmid: 16767357
references.citation: Pathology. 2006 Oct;38(5):468-71
references.pmid: 17008295
references.citation: Endoscopy. 2005 Oct;37(10):990-3
references.pmid: 16189772
references.citation: Ann Surg Oncol. 2008 Feb;15(2):508-13
references.pmid: 18071825
references.citation: Endoscopy. 2010 Oct;42(10):814-9
references.pmid: 20886399
references.citation: Oncol Lett. 2011 Nov;2(6):1197-1202
references.pmid: 22848288
references.citation: World J Gastroenterol. 2008 Jul 7;14(25):4011-9
references.pmid: 18609685
references.citation: Dig Endosc. 2014 Mar;26(2):214-9
references.pmid: 23826719
references.citation: Gastrointest Endosc. 2005 Jul;62(1):48-54
references.pmid: 15990819
references.citation: Br J Surg. 1993 Mar;80(3):325-8
references.pmid: 8472141
references.citation: Dig Endosc. 2010 Apr;22(2):112-8
references.pmid: 20447204
references.citation: Gastric Cancer. 2001;4(1):34-8
references.pmid: 11706625
references.citation: Surgery. 2011 Mar;149(3):356-63
references.pmid: 20727560
references.citation: Surg Endosc. 2013 Dec;27(12):4656-62
references.pmid: 23943115
references.citation: Cancer. 1993 Dec 1;72(11):3174-8
references.pmid: 8242540
references.citation: World J Surg. 1979 Nov;3(6):731-6
references.pmid: 532192
references.citation: World J Gastroenterol. 2007 Jul 21;13(27):3657-61
references.pmid: 17659722
references.citation: Endoscopy. 2011 Feb;43(2):134-9
references.pmid: 21108175
references.citation: Endoscopy. 2013 Sep;45(9):703-7
references.pmid: 23990481
references.citation: Gastric Cancer. 2005;8(2):59-61
references.pmid: 15864709
references.citation: Gastric Cancer. 2009;12(1):6-22
references.pmid: 19390927
references.citation: Gastric Cancer. 2000 Dec;3(4):219-225
references.pmid: 11984739
references.citation: Endoscopy. 1995 Jan;27(1):27-31
references.pmid: 7601031
references.citation: Gastrointest Endosc. 2011 Jun;73(6):1122-34
references.pmid: 21444080
references.citation: J Gastroenterol Hepatol. 2011 Aug;26(8):1262-9
references.pmid: 21443667
references.citation: Gut. 2013 Oct;62(10):1425-32
references.pmid: 22914298
references.citation: J Clin Oncol. 2005 Jul 10;23(20):4490-8
references.pmid: 16002839
references.citation: Int J Gastrointest Cancer. 2006;37(4):133-8
references.pmid: 18080789
references.citation: Cancer. 1992 Sep 1;70(5):1030-7
references.pmid: 1515980
references.citation: Ann Surg. 2007 Jan;245(1):68-72
references.pmid: 17197967
references.citation: Endoscopy. 2001 Mar;33(3):221-6
references.pmid: 11293753
references.citation: Gastrointest Endosc. 2007 Nov;66(5):901-8
references.pmid: 17963876
references.citation: Surg Oncol. 2010 Dec;19(4):221-6
references.pmid: 20471826
references.citation: Surg Oncol. 2009 Jun;18(2):157-61
references.pmid: 19138841
references.citation: Br J Surg. 2012 Dec;99(12):1688-92
references.pmid: 23023388
references.citation: Gut. 1992 Oct;33(10):1318-22
references.pmid: 1446852
references.citation: Gastrointest Endosc. 2011 Sep;74(3):485-93
references.pmid: 21741645
references.citation: Endoscopy. 2008 Jan;40(1):7-10
references.pmid: 18210339
references.citation: Eur J Surg Oncol. 2008 Jan;34(1):36-41
references.pmid: 17442532
references.citation: Gastric Cancer. 2006;9(4):295-302
references.pmid: 17235632
references.citation: Gastrointest Endosc. 2009 May;69(6):1152-60
references.pmid: 19328485
references.citation: Gastric Cancer. 2012 Sep;15 Suppl 1:S19-26
references.pmid: 22237654
references.citation: Obes Surg. 2008 Sep;18(9):1192-9
references.pmid: 18574648
references.citation: J Surg Oncol. 2004 Mar 15;85(4):181-5; discussion 186
references.pmid: 14991872
references.citation: Surgery. 1989 May;105(5):585-92
references.pmid: 2705096