Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Clinicopathologic Features and Outcomes of Endoscopic Submucosal Dissection for Foveolar-Type Adenocarcinoma of the Stomach

  • Minjee Kim (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Tae-Se Kim (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Byung-Hoon Min (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang Won Min (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyuk Lee (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jun Haeng Lee (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Poong-Lyul Rhee (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jae J. Kim (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kyoung-Mee Kim (Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2024.05.03
  • Accepted : 2024.07.09
  • Published : 2024.10.01
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Abstract

Purpose: Foveolar-type adenocarcinoma of the stomach is a rare variant of gastric cancer. The clinicopathological features and outcomes of endoscopic submucosal dissection (ESD) for gastric foveolar-type adenocarcinoma remain unclear. Materials and Methods: This study included 1,161 patients who underwent ESD for single early gastric cancers (EGCs) (78 foveolar-type adenocarcinomas and 1,083 well-differentiated [WD] adenocarcinomas). The clinicopathological features and short- and long-term outcomes of ESD for gastric foveolar-type adenocarcinomas were reviewed and compared with those for WD EGCs. Results: Gastric foveolar-type adenocarcinomas were larger and more likely to exhibit an elevated macroscopic appearance than WD EGCs. Foveolar-type adenocarcinomas exhibited higher rates of lymphatic invasion, histological heterogeneity, and lateral margin involvement than WD EGCs. The en bloc R0 and curative resection rates of foveolar-type adenocarcinoma were 85.9% and 76.9%, respectively. Both foveolar-type adenocarcinoma rates were significantly lower than those of WD EGCs (95.8% and 91.3%, respectively). Lateral margin involvement accounted for 55.6% of the non-curative resection cases of foveolar-type adenocarcinoma. Among patients who underwent curative ESD for foveolar-type adenocarcinoma, no recurrence occurred during the median 62.3 months of follow-up. No lymph node metastases were detected in patients with foveolar-type adenocarcinoma who underwent additional surgery following ESD. The overall and disease-specific survival rates of patients with foveolar-type adenocarcinoma were comparable to those of patients with WD EGC. Conclusions: Gastric foveolar-type adenocarcinomas have distinct clinicopathological features among WD EGCs. Given favorable long-term outcomes after curative resection, ESD can be indicated for early gastric foveolar-type adenocarcinomas.

Keywords

Acknowledgement

We thank Professor Ryoji Kushima (Department of Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan) for his valuable comments on the pathological diagnosis of the cases included in the present study.

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