Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 3944-3952
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3944
Is endoscopic submucosal dissection safe for papillary adenocarcinoma of the stomach?
Hyun Jeong Lee, Gwang Ha Kim, Do Youn Park, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song
Hyun Jeong Lee, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea
Do Youn Park, Department of Pathology, Pusan National University School of Medicine, Busan 602-739, South Korea
Author contributions: Kim GH and Park DY designed the research/study; Jeon HK and Jhi JH analyzed the data; Kim GH and Lee BE performed the study; Lee HJ and Kim GH collected the data; Song GA reviewed the study population data; and Lee HJ and Kim GH wrote the paper.
Supported by Grant of the Korea Healthcare Technology R and D Project, Ministry of Health and Welfare, South Korea, No. HI12C1845.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gwang Ha Kim, MD, PhD, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 602-739, South Korea. doc0224@pusan.ac.kr
Telephone: +82-51-2407869 Fax: +82-51-2448180
Received: September 3, 2014
Peer-review started: September 4, 2014
First decision: October 14, 2014
Revised: October 22, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: April 7, 2015
Processing time: 216 Days and 1.8 Hours
Abstract

AIM: To identify the clinicopathological predictors of lymph node (LN) metastasis and evaluate the outcomes of endoscopic submucosal dissection (ESD) in papillary adenocarcinoma-type early gastric cancers (EGCs).

METHODS: From January 2005 to May 2013, 49 patients who underwent surgical operation and 24 patients who underwent ESD for papillary adenocarcinoma-type EGC were enrolled to identify clinicopathological characteristics and predictive factors of LN metastasis and to evaluate the outcomes of ESD for papillary adenocarcinoma-type EGC.

RESULTS: Most papillary adenocarcinoma-type EGCs were located in the lower third of the stomach and had an elevated macroscopic shape. The overall prevalence of LN metastasis was 18.3% (9/49). The presence of lymphovascular invasion was found to be a predictor of LN metastasis (P = 0.016). According to current indication criteria of ESD, 6 and 11 of the 49 patients had absolute and expanded indications for ESD, respectively. Two patients (11.8%) with expanded indication for ESD had LN metastasis. Of the 24 patients who underwent ESD, 13 (54%) achieved out-of-ESD indication, with 9 of those 13 patients undergoing surgical operation due to non-curative resection.

CONCLUSION: The use of ESD should be carefully considered for papillary adenocarcinoma-type EGC with suspected ESD indication after pre-treatment work-up because of the higher frequency of LN metastasis and additional surgeries.

Keywords: Gastric cancer; Papillary adenocarcinoma; Endoscopic submucosal dissection; Metastasis; Lymph node

Core tip: Papillary adenocarcinoma-type early gastric cancers (EGCs) are classified as differentiated-type adenocarcinoma and, therefore, treated with endoscopic submucosal dissection (ESD) according to the same indication criteria as other differentiated-type adenocarcinoma, such as tubular adenocarcinoma. However, the rate of lymph node metastasis under the current ESD indication criteria was somewhat high, and more than half of the patients who underwent ESD as a primary treatment for papillary carcinoma-type EGC ultimately achieved out-of-ESD indication. Therefore, the use of ESD should be more carefully considered for papillary adenocarcinoma-type EGCs with suspected ESD indication after pre-treatment work-up.