Long-term outcomes after endoscopic submucosal dissection for differentiated-type early gastric cancer that fulfilled expanded indication criteria: a prospective cohort study.

BACKGROUND AND AIM Endoscopic resection for early gastric cancer (EGC) is widely performed. However, there is still a paucity of strong evidence regarding long-term outcomes after endoscopic submucosal dissection (ESD) for the expanded indication criteria of the Japanese guidelines (ver. 2010). METHODS ESD was performed in patients with EGC that met the expanded indication criteria: (1) cT1a, differentiated-type EGC of 2 to 5 cm, ulcer-negative or (2) cT1a, differentiated-type EGC of ≤3 cm, ulcer-positive. Patients whose pathological examination fulfilled the curative resection criteria were then enrolled in this cohort study: negative vertical margin, negative lymphovascular invasion, and (1) pT1a, differentiated-type, and ulcer-negative; (2) pT1a, differentiated-type, ≤3 cm, and ulcer-positive; or (3) pT1b1 ( 2 cm in diameter and ulcer-negative lesions, and 94 (44%) had ≤3 cm and ulcer-positive lesions. The vital status at 5 years after ESD was confirmed in all (100%) patients. No local or metastatic recurrence was detected; however, 26 metachronous gastric cancers developed, and 1 patient died of metachronous gastric cancer. The 5-year disease-specific and overall survival rates were 99.5% (95% CI, 97.2%-100%) and 93.9% (95% CI, 89.8%-96.4%), respectively. CONCLUSION ESD for EGC that fulfills the expanded criteria is feasible and shows favorable long-term outcomes.