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Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases

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Abstract

Purpose

Endoscopic submucosal dissection is recommended for early gastric cancer with a low risk of lymph node metastasis. When the pathological findings do not meet the curative criteria; then, an additional gastrectomy with lymph node dissection is recommended. However, most cases have neither lymph node metastasis nor a local residual tumor during an additional surgery.

Methods

This was a single-institutional retrospective cohort study, analyzing 200 patients who underwent an additional gastrectomy after non-curative endoscopic submucosal dissection from January 2005 to October 2015. We reviewed the patients’ clinicopathological data and evaluated the predictors for the presence of a residual tumor.

Results

Histopathology revealed lymph node metastasis in 15 patients (7.5 %) and a local residual tumor in 23 (11.5 %). A multivariable analysis revealed macroscopic findings (flat/elevated type) (p = 0.011, odds ratio = 4.63), lymphatic invasion (p < 0.0001, odds ratio = 14.2), and vascular invasion (p = 0.04, odds ratio = 4.00) to be predictors for lymph node metastasis. A positive vertical margin (p = 0.0027, odds ratio = 3.26) and horizontal margin (p = 0.0008, odds ratio = 5.74) were predictors for a local residual tumor. All cases with lymph node metastasis had lymphovascular invasion with at least one other non-curative factor.

Conclusions

The risk of a residual tumor can, therefore, be estimated based on the histopathology of endoscopic submucosal dissection samples. Lymphovascular invasion appears to be a pivotal predictor of lymph node metastasis.

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Authors and Affiliations

  1. Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Chiba, Japan

    Hideki Sunagawa, Takahiro Kinoshita, Akio Kaito, Hidehito Shibasaki & Toshirou Nishida

  2. Endoscopy Division, Department of Gastroenterology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan

    Kazuhiro Kaneko

  3. Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan

    Atsushi Ochiai

  4. Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan

    Atsushi Ohtsu

  5. Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan

    Hideki Sunagawa & Atsushi Ohtsu

Authors
  1. Hideki Sunagawa
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  2. Takahiro Kinoshita
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  3. Akio Kaito
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  4. Hidehito Shibasaki
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  5. Kazuhiro Kaneko
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  6. Atsushi Ochiai
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  7. Atsushi Ohtsu
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  8. Toshirou Nishida
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Corresponding author

Correspondence to Takahiro Kinoshita.

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Sunagawa, H., Kinoshita, T., Kaito, A. et al. Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases. Surg Today 47, 202–209 (2017). https://doi.org/10.1007/s00595-016-1353-1

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  • DOI: https://doi.org/10.1007/s00595-016-1353-1

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