Discrepancy between Clinical and Final Pathological Evaluation Findings in Early Gastric Cancer Patients Treated with Endoscopic Submucosal Dissection.
OBJECTIVE
Early gastric cancer cases that are estimated to meet indications for treatment before endoscopic submucosal resection are often revealed to be out-of-indication after the treatment. We investigated the short-term treatment outcomes in patients with early gastric cancer according to the pretreatment clinical endoscopic submucosal resection indications.


METHODS
We retrospectively reviewed the medical records of patients with early gastric cancer that met the pretreatment endoscopic submucosal resection indications, from 2004 to 2011. Curative resection rate and proportion of out-of-indication cases were compared according to the pre-endoscopic submucosal resection indications. Pre-endoscopic submucosal resection factors associated with out-of-indication in the final pathological examination were analyzed.


RESULTS
Of 756 cases, 660 had absolute and 96 had expanded pre-endoscopic submucosal resection indications. The curative resection rate was significantly lower in the patients with expanded indications (64.6%) than in those with absolute indications (81.7%; P<0.001). The cases with expanded indications (30.2%) were revealed to be out-of-indication more frequently than the cases with absolute indications (13.8%; P<0.001). Age of >65 years, tumor size of >2 cm, tumor location in the upper-third segment of the stomach, and undifferentiated histological type in pre-endoscopic submucosal resection evaluations were significant risk factors for out-of-indication after endoscopic submucosal resection.


CONCLUSIONS
Non-curative resection due to out-of-indication occurred in approximately one-third of the early gastric cancer cases that clinically met the expanded indications before endoscopic submucosal resection. The possibility of additional surgery should be emphasized for patients with early gastric cancers that clinically meet the expanded indications.
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Young-Il
YI
Kim
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Hyoung Sang
HS
Kim
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Myeong-Cherl
MC
Kook
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Soo-Jeong
SJ
Cho
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Jong Yeul
JY
Lee
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Chan Gyoo
CG
Kim
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Keun Won
KW
Ryu
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Young-Woo
YW
Kim
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Il Ju
IJ
Choi
Criteria; Early gastric cancer; Endoscopic submucosal dissection