title: Factors Associated With Outcomes in Endoscopic Submucosal Dissection of Gastric Cardia Tumors: A Retrospective Observational Study.
abstract: Tumors of the gastric cardia are among the most technically difficult lesions to remove by endoscopic submucosal dissection (ESD). This study aimed to evaluate the therapeutic outcomes of ESD in gastric cardia tumors according to clinicopathologic characteristics, and to assess the predictive factors for incomplete resection.We conducted a retrospective observational study of 82 patients with adenomas and early cancers of the gastric cardia who underwent ESD between January 2006 and December 2013 at the Pusan National University Hospital. Therapeutic outcomes of ESD and procedure-related complications were analyzed.En bloc resection, complete resection, and curative resection rates were 87%, 79%, and 66%, respectively. Deep submucosal invasion was the most common cause of noncurative resection in the cases in which complete resection was achieved. On multivariate analyses, hemispheric distribution (anterior hemisphere; odds ratio [OR] 4.808) and depth of tumor invasion (submucosal cancer; OR 22.056) were independent factors associated with incomplete resection. The rates of procedure-related bleeding, perforation, and stenosis were 6%, 1%, and 0%, respectively; none of the complications required surgical intervention.In conclusion, ESD is a safe, effective, and feasible treatment for gastric cardia tumors. However, the complete resection rate decreases for tumors that are located in the anterior hemisphere or have deep submucosal invasion.
authors.affiliation: From the Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital (YSJ, BEL, GHK, HKJ, DHB, DUK, GAS) and Department of Pathology, Pusan National University School of Medicine, Busan, Republic of Korea (DYP).
authors.forename: Yae Su
authors.initials: YS
authors.lastname: Jang
authors.forename: Bong Eun
authors.initials: BE
authors.lastname: Lee
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.forename: Do Youn
authors.initials: DY
authors.lastname: Park
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Jeon
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Baek
authors.forename: Dong Uk
authors.initials: DU
authors.lastname: Kim
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome