1Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
4Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
5Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
6Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea
7Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
8Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
Copyright © 2017 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Author contributions
Conceptualization: Chang Seok Bang, Jae Myung Park, Gwang Ho Baik, Jong Jae Park
Data curation: CSB, JMP, GHB, JJP, Moon Kyung Joo, Jae Young Jang, Seong Woo Jeon, Suck Chei Choi, Jae Kyu Sung, Kwang Bum Cho
Formal analysis: CSB, GHB
Supervision: GHB, JJP
Writing-original draft: CSB
Writing-review&editing: GHB, JJP
Overall outcomes (n=275) | Outcomes in lesions with expanded indication (n=82) | Outcomes in lesions with beyond expanded indication (n=193) | p-value | |
---|---|---|---|---|
En bloc resection | 254 (92.4%) | 77 (93.9%) | 177 (91.7%) | 0.63 |
Complete resection | 220 (80%) | 68 (82.9%) | 152 (78.8%) | 0.51 |
Curative resection | 100 (36.4%) | 40 (48.8%) | 60 (31.1%) | 0.006 |
Resection margin involvement | 42 (15.3%) | 10 (12.2%) | 32 (16.6%) | 0.41 |
Lateral margin | 14 (5.1%) | 4 (4.9%) | 10 (5.2%) | |
Vertical margin | 21 (7.6%) | 6 (7.3%) | 15 (7.8%) | |
Both margin | 7 (2.5%) | 0 (0%) | 7 (3.6%) | |
Depth of invasion | 0.78 | |||
Mucosal lesion | 176 (64%) | 54 (65.9%) | 122 (63.2%) | |
Submucosal lesion | 99 (36%) | 28 (34.1%) | 71 (36.8%) | |
Lymphovascular invasion | 26 (9.5%) | 6 (7.3%) | 20 (10.4%) | 0.51 |
Complications | ||||
Delayed bleedinga) | 2 (0.7%) | 0 (0%) | 2 (1.0%) | 0.12 |
Perforation | 5 (1.8%) | 3 (3.7%) | 2 (1.0%) | 0.25 |
Procedure time, min, median (IQR) | 50 (33-76) | 45 (31.8-64.3) | 60 (33.5-88) | 0.02 |
Overall outcomes (n=275) | Outcomes in lesions with expanded criteria (n=109) | Outcomes in lesions with beyond expanded criteria (n=166) | p-value | |
---|---|---|---|---|
En bloc resection | 254 (92.4%) | 104 (95.4%) | 150 (90.4%) | 0.16 |
Complete resection | 220 (80%) | 100 (91.7%) | 120 (72.3%) | <0.001 |
Curative resection | 100 (36.4%) | 100 (91.7%) | Not applicable | Not applicable |
Resection margin involvement | 42 (15.3%) | 5 (4.6%) | 37 (22.3%) | <0.001 |
Lateral margin | 14 (5.1%) | 3 (2.8%) | 11 (6.6%) | |
Vertical margin | 21 (7.6%) | 2 (1.8%) | 19 (11.4%) | |
Both margin | 7 (2.5%) | 0 (0%) | 7 (4.2%) | |
Depth of invasion | <0.001 | |||
Mucosal lesion | 176 (64%) | 109 (100%) | 67 (40.4%) | |
Submucosal lesion | 99 (36%) | 0 (0%) | 99 (59.6%) | |
Lymphovascular invasion | 26 (9.5%) | 4 (3.7%) | 22 (13.3%) | 0.01 |
Complications | ||||
Delayed bleedinga) | 2 (0.7%) | 0 (0%) | 2 (1.2%) | 0.49 |
Perforation | 5 (1.8%) | 1 (0.9%) | 4 (2.4%) | 0.17 |
Procedure time, min, median (IQR) | 50 (33-76) | 41 (29-70) | 59 (37.8-80) | 0.002 |
Overall outcomes (n=275) | Outcomes in poorly differentiated adenocarcinoma (n=186) | Outcomes in signet ring cell carcinoma (n=89) | p-value | |
---|---|---|---|---|
En bloc resection | 254 (92.4%) | 171 (91.9%) | 83 (93.3%) | 0.81 |
Complete resection | 220 (80%) | 146 (78.5%) | 74 (83.1%) | 0.42 |
Curative resection | 100 (36.4%) | 67 (36%) | 33 (37.1%) | 0.89 |
Resection margin involvement | 42 (15.3%) | 30 (16.1%) | 12 (13.5%) | 0.21 |
Lateral margin | 14 (5.1%) | 8 (4.3%) | 6 (6.7%) | |
Vertical margin | 21 (7.6%) | 18 (9.7%) | 3 (3.4%) | |
Both margin | 7 (2.5%) | 4 (2.2%) | 3 (3.4%) | |
Depth of invasion | 0.003 | |||
Mucosal lesion | 176 (64%) | 108 (58.1%) | 68 (76.4%) | |
Submucosal lesion | 99 (36%) | 78 (41.9%) | 21 (23.6%) | |
Lymphovascular invasion | 26 (9.5%) | 21 (11.3%) | 5 (5.6%) | 0.19 |
Complications | ||||
Delayed bleedinga) | 2 (0.7%) | 1 (0.5%) | 1 (1.1%) | 0.54 |
Perforation | 5 (1.8%) | 3 (1.6%) | 2 (2.2%) | 0.7 |
Procedure time, min, median (IQR) | 50 (33-76) | 50 (33-72.3) | 50 (30-83.5) | 0.94 |
Age, yr, median (IQR) | 69 (60-76) |
Sex, men: women (%) | 165 (60%): 110 (40%) |
Tumor location (%) | |
Antrum | 131 (47.6%) |
Low body | 83 (30.2%) |
Mid body | 28 (10.2%) |
Upper body, cardia | 33 (12%) |
Macroscopic type (%) | |
Elevated | 101 (36.7%) |
Flat | 98 (35.6%) |
Depressed | 76 (27.6%) |
Lesion size, pre-ER measurement (mm), median (IQR) | 25 (15-40) |
Lesion size, post-ER measurement (mm), median (IQR) | 18 (11-26) |
Depth of invasion | |
Mucosal lesion | 176 (64%) |
Submucosal lesion | 99 (36%) |
Histology, pre-ER (%) | |
Adenocarcinoma, poorly differentiated | 89 (32.4%) |
Signet ring cell carcinoma | 59 (21.5%) |
Adenocarcinoma, moderately differentiated | 55 (20%) |
Adenocarcinoma, well differentiated | 32 (11.6%) |
Low-grade dysplasia | 15 (5.5%) |
High-grade dysplasia | 13 (4.7%) |
Atypical cells or unknown | 12 (4.4%) |
Histology, post-ER (%) | |
Adenocarcinoma, poorly differentiated | 186 (67.6%) |
Signet ring cell carcinoma | 89 (32.4%) |
Resection method (%) | |
ESD | 250 (90.9%) |
EMR | 25 (9.1%) |
Pre-ER indication | |
Expanded indication | 82 (29.8%) |
Beyond expanded indication | 193 (70.2%) |
Post-ER criteria | |
Expanded criteria | 108 (39.3%) |
Beyond expanded criteria | 167 (60.7%) |
Helicobacter pylori infection (%) | |
Uninfected | 82 (29.8%) |
Infected | 110 (40%) |
Unknown | 83 (30.2%) |
Follow-up duration, yr, median (IQR) | 3.96 (1.11-5.09) |
Lost to follow-up (%) | 17 (6.2%) |
Overall outcomes (n=275) | Outcomes in lesions with expanded indication (n=82) | Outcomes in lesions with beyond expanded indication (n=193) | p-value | |
---|---|---|---|---|
En bloc resection | 254 (92.4%) | 77 (93.9%) | 177 (91.7%) | 0.63 |
Complete resection | 220 (80%) | 68 (82.9%) | 152 (78.8%) | 0.51 |
Curative resection | 100 (36.4%) | 40 (48.8%) | 60 (31.1%) | 0.006 |
Resection margin involvement | 42 (15.3%) | 10 (12.2%) | 32 (16.6%) | 0.41 |
Lateral margin | 14 (5.1%) | 4 (4.9%) | 10 (5.2%) | |
Vertical margin | 21 (7.6%) | 6 (7.3%) | 15 (7.8%) | |
Both margin | 7 (2.5%) | 0 (0%) | 7 (3.6%) | |
Depth of invasion | 0.78 | |||
Mucosal lesion | 176 (64%) | 54 (65.9%) | 122 (63.2%) | |
Submucosal lesion | 99 (36%) | 28 (34.1%) | 71 (36.8%) | |
Lymphovascular invasion | 26 (9.5%) | 6 (7.3%) | 20 (10.4%) | 0.51 |
Complications | ||||
Delayed bleeding |
2 (0.7%) | 0 (0%) | 2 (1.0%) | 0.12 |
Perforation | 5 (1.8%) | 3 (3.7%) | 2 (1.0%) | 0.25 |
Procedure time, min, median (IQR) | 50 (33-76) | 45 (31.8-64.3) | 60 (33.5-88) | 0.02 |
Overall outcomes (n=275) | Outcomes in lesions with expanded criteria (n=109) | Outcomes in lesions with beyond expanded criteria (n=166) | p-value | |
---|---|---|---|---|
En bloc resection | 254 (92.4%) | 104 (95.4%) | 150 (90.4%) | 0.16 |
Complete resection | 220 (80%) | 100 (91.7%) | 120 (72.3%) | <0.001 |
Curative resection | 100 (36.4%) | 100 (91.7%) | Not applicable | Not applicable |
Resection margin involvement | 42 (15.3%) | 5 (4.6%) | 37 (22.3%) | <0.001 |
Lateral margin | 14 (5.1%) | 3 (2.8%) | 11 (6.6%) | |
Vertical margin | 21 (7.6%) | 2 (1.8%) | 19 (11.4%) | |
Both margin | 7 (2.5%) | 0 (0%) | 7 (4.2%) | |
Depth of invasion | <0.001 | |||
Mucosal lesion | 176 (64%) | 109 (100%) | 67 (40.4%) | |
Submucosal lesion | 99 (36%) | 0 (0%) | 99 (59.6%) | |
Lymphovascular invasion | 26 (9.5%) | 4 (3.7%) | 22 (13.3%) | 0.01 |
Complications | ||||
Delayed bleeding |
2 (0.7%) | 0 (0%) | 2 (1.2%) | 0.49 |
Perforation | 5 (1.8%) | 1 (0.9%) | 4 (2.4%) | 0.17 |
Procedure time, min, median (IQR) | 50 (33-76) | 41 (29-70) | 59 (37.8-80) | 0.002 |
Overall outcomes (n=275) | Outcomes in poorly differentiated adenocarcinoma (n=186) | Outcomes in signet ring cell carcinoma (n=89) | p-value | |
---|---|---|---|---|
En bloc resection | 254 (92.4%) | 171 (91.9%) | 83 (93.3%) | 0.81 |
Complete resection | 220 (80%) | 146 (78.5%) | 74 (83.1%) | 0.42 |
Curative resection | 100 (36.4%) | 67 (36%) | 33 (37.1%) | 0.89 |
Resection margin involvement | 42 (15.3%) | 30 (16.1%) | 12 (13.5%) | 0.21 |
Lateral margin | 14 (5.1%) | 8 (4.3%) | 6 (6.7%) | |
Vertical margin | 21 (7.6%) | 18 (9.7%) | 3 (3.4%) | |
Both margin | 7 (2.5%) | 4 (2.2%) | 3 (3.4%) | |
Depth of invasion | 0.003 | |||
Mucosal lesion | 176 (64%) | 108 (58.1%) | 68 (76.4%) | |
Submucosal lesion | 99 (36%) | 78 (41.9%) | 21 (23.6%) | |
Lymphovascular invasion | 26 (9.5%) | 21 (11.3%) | 5 (5.6%) | 0.19 |
Complications | ||||
Delayed bleeding |
2 (0.7%) | 1 (0.5%) | 1 (1.1%) | 0.54 |
Perforation | 5 (1.8%) | 3 (1.6%) | 2 (2.2%) | 0.7 |
Procedure time, min, median (IQR) | 50 (33-76) | 50 (33-72.3) | 50 (30-83.5) | 0.94 |
All population (n=275) | Curative resection (n=100) | Non-curative resection (n=175) | Poorly differentiated adenocarcinoma (n=186) | Signet ring cell carcinoma (n=89) | Pre-ER expanded indication (n=82) | Pre-ER beyond expanded indication (n=193) | Post-ER expanded criteria (n=109) | Post-ER beyond expanded criteria (n=166) | |
---|---|---|---|---|---|---|---|---|---|
Recurrence | 28 (10.2%) | 10 (10%) | 18 (10.3%) | 14 (7.5%) | 14(15.7%) | 12 (14.6%) | 16(8.3%) | 10 (9.2%) | 18 (10.8%) |
Log-rank test | 0.28 | 0.11 | 0.02 | 0.21 | |||||
Recurrence period, mon, median (IQR) | 13.6 (2.4-47.7) | 39.6 (13.4-59.2) | 7.6 (2.2-28.7) | 21.7 (7.5-50.7) | 6.3 (2-40.5) | 28.3 (8.4-57.8) | 6.3 (2-40.5) | 39.6(13.4-59.2) | 7.6 (2.2-28.7) |
Death | 5 (1.8%) | 1 (1%) | 4(2.3%) | 4(2.2%) | 1 (1.1%) | 1 (1.2%) | 4(2.1%) | 1 (0.9%) | 4(2.4%) |
Log-rank test | 0.32 | 0.43 | 0.65 | 0.30 | |||||
Cancer-related death | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
IQR, interquartile range; ER, endoscopic resection; ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal resection.
ER, endoscopic resection; IQR, interquartile range; ESD, endoscopic submucosal dissection. Hemorrhage occurring 96 hours after ESD.
ER, endoscopic resection; IQR, interquartile range; ESD, endoscopic submucosal dissection. Hemorrhage occurring 96 hours after ESD.
IQR, interquartile range; ESD, endoscopic submucosal dissection. Hemorrhage occurring 96 hours after ESD.
ER, endoscopic resection; IQR, interquartile range.