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Optimal management for patients not meeting the inclusion criteria after endoscopic submucosal dissection for gastric cancer

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Abstract

Background

The necessity of additional gastrectomy for patients not meeting the inclusion criteria after endoscopic submu cosal dissection (ESD) is controversial. The aim of this study was to elucidate the risk factors for lymph node metastasis (LNM) and residual cancer (RC) in patients not meeting the inclusion criteria after ESD and to determine additional treatment strategies.

Methods

Of 1443 gastric cancer patients who underwent ESD between 2004 and 2013, 167 patients diagnosed as having a lesion not meeting the inclusion criteria after ESD were retrospectively analyzed. Of the 167 cases, 100 cases underwent additional gastrectomy, and 67 cases were observed without surgery.

Results

Overall, 9.0 % (9/100) and 9.0 % (9/100) of patients not meeting the inclusion criteria after ESD presented with LNM and RC, respectively, but neither was observed in 83 patients (83.0 %). Multivariate analysis revealed that lymphovascular involvement (LVI) (OR 38.38; 95 % CI 1.94–761.43, p = 0.017) and undifferentiated type (OR 45.58; 95 % CI 2.88–720.94, p = 0.007) were independent risk factors for LNM, and positive horizontal margin was an independent risk factor for RC (OR 9.48; 95 % CI 1.72–52.13, p = 0.010). In differentiated types without LVI, no cases had LNM (0/38) in the additional gastrectomy group, and there was no lymph node or distant recurrence (0/39) in the observation group.

Conclusions

Additional treatment is necessary for patients with LVI, undifferentiated type, and positive horizontal margin. Careful follow-up may be acceptable for patients with the differentiated type without LVI, especially for the elderly or patients with severe comorbidities.

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Authors and Affiliations

  1. Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Takahiro Toyokawa, Masaichi Ohira, Hiroaki Tanaka, Katsunobu Sakurai, Naoshi Kubo, Kazuya Muguruma & Kosei Hirakawa

  2. Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan

    Hiroaki Minamino, Yasuaki Nagami, Kazunari Tominaga & Tetsuo Arakawa

  3. Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan

    Atsushi Yamamoto & Yoshito Yamashita

  4. Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan

    Koji Sano & Hiroko Nebiki

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  1. Takahiro Toyokawa
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  2. Masaichi Ohira
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Correspondence to Masaichi Ohira.

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Disclosures

Takahiro Toyokawa, Masaichi Ohira, Hiroaki Tanaka, Hiroaki Minamino, Katsunobu Sakurai, Yasuaki Nagami, Naoshi Kubo, Atsushi Yamamoto, Koji Sano, Kazuya Muguruma, Kazunari Tominaga, Hiroko Nebiki, Yoshito Yamashita, Tetsuo Arakawa, Kosei Hirakawa have no conflicts of interest or financial ties to disclose.

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Toyokawa, T., Ohira, M., Tanaka, H. et al. Optimal management for patients not meeting the inclusion criteria after endoscopic submucosal dissection for gastric cancer. Surg Endosc 30, 2404–2414 (2016). https://doi.org/10.1007/s00464-015-4491-4

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  • DOI: https://doi.org/10.1007/s00464-015-4491-4

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