Histomorphologic features of early gastric carcinoma treated by endoscopic submucosal dissection: relation to efficiency of endoscopic resection.
OBJECTIVE
Early gastric cancer (EGC) is defined as cancer invasion confined to the mucosa or submucosa, irrespective of lymph node metastasis. Recently endoscopic submucosal dissection (ESD) has been widely accepted for the treatment for dysplasia and EGC without lymph node metastases. While the method has been advanced in Far East countries, ESD is still being developed in Europe and has not gained enough popularity although it has been recommended as the treatment of choice for superficial gastric neoplastic lesions by European Society of Gastrointestinal Endoscopy (ESGE) in 2015.


METHODS
The aim of the study was to perform a retrospective analysis of clinical and histomorphologic features of 58 cases of EGCs removed by ESD in a university hospital in Western Pomerania in Poland and to evaluate factors related to the efficiency of ESD resection.


RESULTS
With univariate analysis, indications for ESD with the highest R0 rate were found in EGCs limited to mucosa (T1a, small mucosal, M), without muscularis mucosa invasion, localised in the middle/lower part of stomach and intestinal type in histological examination. The R0 complete resection rate was significantly (p < 0.0001) lower for T1b than that for T1a tumours (21.4% vs. 100%). Tumours with submucosal involvement were associated with lower efficiency of ESD procedure.


CONCLUSIONS
Our data showed that in EGCs with favourable histomorphologic characteristics, ESD seemed to be a totally efficient and safe method of treatment in a European small-volume centre. R0 resection rate reached 81.1% of cases and median time of the ESD procedure was 61.5 min.
a Department of Pathology , Pomeranian Medical University , Szczecin , Poland.
Katarzyna
K
Karpińska-Kaczmarczyk
b Department of Gastroenterology , Pomeranian Medical University , Szczecin , Poland.
Andrzej
A
Białek
a Department of Pathology , Pomeranian Medical University , Szczecin , Poland.
Magdalena
M
Lewandowska
a Department of Pathology , Pomeranian Medical University , Szczecin , Poland.
Ewa
E
Dobak
b Department of Gastroenterology , Pomeranian Medical University , Szczecin , Poland.
Małgorzata
M
Ławniczak
a Department of Pathology , Pomeranian Medical University , Szczecin , Poland.
Elżbieta
E
Urasińska
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D011044:Poland; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*
Early gastric cancer; endoscopic submucosal dissection; histological classification; resection rates