Management of non-curative endoscopic submucosal dissection for early gastric cancer: do we have enough data to support this?

Gastric cancer is one of the most common cancers. Early gastric cancer (EGC) detection is critical for its curative or even non-curative treatment. Gotoda et al. provided important information on the risks of lymph node metastasis (LNM) in a large EGC series (1). Based on their analyses, the expanded criteria for the endoscopic resection of EGC was proposed as follows mucosal cancer without ulcer findings irrespective of tumor size; mucosal cancer with ulcer findings less than 3 cm in diameter; and minute (<500 μm from the muscularis mucosae) submucosal invasive cancer less than 3 cm in size due to their nominal risks of LNM. Endoscopic submucosal dissection (ESD) has been developed worldwide as an endoluminal therapeutic technique for EGC (2). ESD allows precise histological assessment of the resected one-piece specimens in order to guide further management and to stratify a patient’s risk for developing metastasis including LNM. The long-term outcome of curative EGC patients treated by ESD can be excellent; our previous study showed for the first time that the 5-year overall survival (OS) and disease specific survival (DSS) rates of EGC patients treated by ESD were 97.1% and 100%, respectively (3).