Published online Feb 7, 2014. doi: 10.3748/wjg.v20.i5.1365
Revised: November 21, 2013
Accepted: December 5, 2013
Published online: February 7, 2014
Epstein-Barr virus (EBV)-associated lymphoepithelioma-like gastric carcinoma (LELC) is characterized by a lower lymph node (LN) metastasis rate and a higher survival rate than other forms of gastric cancer. Although current prognosis for LELC is favorable, the most common approach is radical gastrectomy involving an extensive D2 lymph node dissection. Here, we report four cases of EBV-associated early LELC that were treated by an alternative approach, endoscopic submucosal dissection (ESD). The long-term outcome of this procedure is discussed. All patients were treated by ESD en bloc, and all ESD specimens showed tumor-free lateral resection margins. None of the lesions showed lymphovascular invasion. A pathological examination of ESD specimens revealed submucosal invasion of more than 500 μm in all four cases. One patient underwent additional radical surgery post-ESD; no residual tumor or LN metastasis was noted in the surgical specimen. The other three patients did not undergo additional surgery, either because of severe comorbidity or their refusal to undergo operation, but were subjected to medical follow-up. None of the ESD-treated patients reported local recurrence or distant metastases during the 27-32 mo of follow-up after ESD.
Core tip: The present case studies indicate that treatment of Epstein-Barr virus (EBV)-associated early lymphoepithelioma-like gastric carcinoma (LELC) by endoscopic submucosal dissection (ESD) might have favorable long-term outcomes, despite deep submucosal invasion of tumor cells. Therefore, a conservative management strategy without additional surgery might be considered for EBV-positive early LELC with submucosal invasion treated by ESD, especially in patients with severe comorbidity and high operative risk.