title: [Application of endoscopic submucosal dissection in treatment of early gastric cancer].
abstract: OBJECTIVE
  To evaluate the clinical outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in a single center in China.
  
  
  METHODS
  We performed a retrospective analysis of the patients with single EGC lesion who received ESD in Peking University Cancer Hospital from January 2011 to December 2013.Their clinicopathologic data, resectability, curability, complications and follow-up data were assessed.
  
  
  RESULTS
  A total of 116 patients were enrolled in the study. The patients included 88 men and 28 women, with a median age of 63 years (range: 25-80 years).The post-operative histology of the lesions included 28 (24.1%) high grade intraepithelial neoplasia, 35 (30.2%) well differentiated adenocarcinoma, 35 (30.2%) moderated differentiated adenocarcinoma and 18 (15.5%) poorly differentiated adenocarcinoma. Of all the lesions, 75.0% (87/116) were confined into mucosa, 15.5% (18/116) invaded SM1 (<500 μm from the muscularis mucosae) and 9.5% (11/116) invaded SM2 (≥ 500 μm from the muscularis mucosae). The mean tumor size was (1.49 ± 0.96) cm, and the rate of ulceration was 14.7% (17/116). The en bloc resection rates were 96.7% (111/116), complete resection rates were 93.1% (108/116) and curative resection rates were 77.6% (90/116). According to the curability, 62 (53.4%) cases were classified into the standard curative resection (sCR) group, 28 (24.2%) into the expanded curative resection (eCR) group and 26 (22.4%) into the non-curative resection (nCR) group. The mean tumor size of the sCR group was smaller than that of the eCR and nCR group (t=-4.121, P<0.001 and t=-3.420, P=0.001). In the nCR group, the portion of type 0-III lesion and ulceration were significantly higher (χ² = 10.287, P=0.006 and χ² = 17.737, P<0.001). In multivariate analysis, EGC with ulceration and submucosal invasion were the risk factors for non-curative resection (OR=6.634, P=0.006 and OR=12.735, P<0.001). The ESD-related complications included 4 (3.4%) post-operative bleeding, 3 (2.6%) intra-operative perforation, 2 (1.7%) cardiac stenosis and 1 (0.9%) heart failure. In the study, 106 of the 116 patients received periodic follow-up, during a median follow-up of 22 months (12-47 months). Local tumor recurrence developed in 1 patient of the eCR group 8 months post the ESD.
  
  
  CONCLUSIONS
  ESD is a safe and feasible option for EGC in China, ulceration and submucosal invasion are associated with non-curative resection, and post-operative bleeding and intra-operative perforation should be concerned as the main complications.
authors.affiliation: Department of Endoscopy Center, Peking University Cancer Hospital & Institute ; Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education, Beijing 100142, China.
authors.forename: Shi-jie
authors.initials: SJ
authors.lastname: Li
authors.affiliation: Department of Endoscopy Center, Peking University Cancer Hospital & Institute ; Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education, Beijing 100142, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute ; Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education, Beijing 100142, China.
authors.forename: Zi-yu
authors.initials: ZY
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute ; Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education, Beijing 100142, China.
authors.forename: Zhao-de
authors.initials: ZD
authors.lastname: Bu
authors.affiliation: Department of Gastrointestinal Microinvasive Surgery, Peking University Cancer Hospital & Institute ; Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education, Beijing 100142, China.
authors.forename: Xiang-qian
authors.initials: XQ
authors.lastname: Su
authors.affiliation: Department of Pathology, Peking University Cancer Hospital & Institute ; Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education, Beijing 100142, China.
authors.forename: Zhong-wu
authors.initials: ZW
authors.lastname: Li
authors.affiliation: Department of Endoscopy Center, Peking University Cancer Hospital & Institute ; Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education, Beijing 100142, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wu
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; D055088:Early Detection of Cancer; D004724:Endoscopy; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome