Published online Apr 14, 2024. doi: 10.3748/wjg.v30.i14.1990
Peer-review started: December 21, 2023
First decision: January 30, 2024
Revised: February 12, 2024
Accepted: March 19, 2024
Article in press: March 19, 2024
Published online: April 14, 2024
Processing time: 113 Days and 3.6 Hours
Timely intervention in early gastric cancer can improve the 5-year survival rate to more than 90%. Endoscopic submucosal dissection (ESD) is a safe and mature endoscopic treatment method, but its indications, postoperative management strategies and related influencing factors are still under exploration.
The aim of this study was to explore the underlying factors affecting the development of gastric mucosal tumors, the efficacy of ESD and the underlying scientific prevention and treatment strategies after surgery.
The epidemiological, clinical, and endoscopic features and ESD efficacy of gastric mucosal tumors with different degrees of differentiation were analyzed by stratification, and the related risk factors affecting preoperative diagnosis, ESD efficacy and long-term disease-free survival (DFS) were explored.
According to the latest Japanese guidelines (sixth edition), 301 patients with gastric mucosal tumors treated with ESD at our center from 2014 to 2021 were enrolled, and followed up by endoscopy and chest and abdominal computed tomography at 3, 6 and 12 months after surgery for monitoring, and the data were retrospectively analyzed.
The greater the degree of differentiation of the lesion is, the more likely the lesion is to develop into depression, the deeper the infiltration depth, the more obvious the magnified endoscopy with narrow-band imaging (ME + NBI) abnormality, and the more postoperative complications and adverse outcomes there are. The overall survival rates at 2, 5 and 8 years were 99.0%, 97.7% and 95.7%, respectively, and the DFS rates were 95.0%, 90.1% and 86.9%, respectively. Undifferentiated lesions (HR 5.066), coating with white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were risk factors for poor prognosis.
Before ESD, it is necessary to strictly screen lesions that meet the indications and be aware of the risk factors that affect the efficacy of ESD. Patients with high-risk factors should be followed up more closely after surgery to identify any recurrence and metastasis in a timely manner. After noncurative resection, additional surgical resection and lymph node dissection should be performed according to the patient’s condition.
A large-scale, multicenter retrospective study in Northwest China is needed to increase the sample size and the number of positive outcomes, and further exploration of treatment options for patients with noncurative resections is necessary.