Comparison of endoscopic submucosal dissection and surgery for early signet-ring cell carcinoma of the stomach: a multicenter study.

Authors

Xinying Yu, Jian Chen, Xiao Liu

Published in

Journal of gastrointestinal oncology. Volume 17. Issue 3. Pages 138. Jun 30, 2026. Epub May 22, 2026.

Abstract

The optimal treatment strategy for early gastric signet-ring cell carcinoma (SRCC) remains controversial. This multicenter retrospective study aimed to evaluate the perioperative safety and short-term oncological outcomes of endoscopic submucosal dissection (ESD) versus radical gastrectomy in a strictly defined cohort of patients with early pure gastric SRCC, and to generate hypotheses that may inform future randomized trials and refine patient selection criteria.
We retrospectively reviewed the clinical and pathological data of consecutive patients with early pure gastric SRCC who underwent ESD or radical surgery across three centers between April 2018 and April 2024. Preoperative staging included contrast-enhanced computed tomography (CT) and endoscopic ultrasound (EUS). Clinicopathological characteristics, operative parameters, depth of invasion, lymphovascular invasion (LVI), and lymph node metastasis (LNM) were evaluated. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to address baseline imbalances.
A total of 124 patients (44 in the ESD group and 80 in the surgical group) were enrolled. The ESD group demonstrated significantly shorter operative times (58.1±21.9 vs. 144.5±54.7 min, P<0.001) and reduced lengths of hospital stay (6.1±1.1 vs. 14.1±5.1 days, P<0.001). After PSM (29 pairs), the LNM rate was comparable between groups (ESD 0/29 vs. surgery 1/29, P=0.31). In the expanded-criteria subgroup (ESD n=31, surgery n=30), there was no significant difference in postoperative LNM (0% vs. 3.4%, P>0.99). Multivariate analysis identified submucosal invasion [odds ratio (OR) =4.80, 95% confidence interval (CI): 1.05-21.90, P=0.043] and ulceration (OR =5.20, 95% CI: 1.10-24.60, P=0.04) as independent risk factors for LNM. The model exhibited adequate calibration (Hosmer-Lemeshow test, P=0.68).
For carefully selected patients with early gastric pure SRCC who strictly meet the expanded indications, ESD may be a feasible minimally invasive option with favorable perioperative outcomes. In this retrospective, hypothesis-generating analysis with limited sample size and low event rates, ESD was not associated with inferior short-term oncological outcomes compared to surgery. However, these findings should be interpreted with caution and do not establish therapeutic equivalence.

PMID:
42434271
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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