Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3944
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
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.
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.