Abstract
Background
The aim of this study was to identify the risk factors for residual/recurrent tumors in patients with a tumor-positive lateral resection margin (LRM+) after endoscopic resection of early gastric cancer (EGC) and to establish the criteria for performing additional treatment.
Methods
A retrospective analysis was performed on consecutive patients who underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of EGC. Clinicopathological characteristics and risk factors for residual/recurrent tumor in LRM+ patients were analyzed.
Results
Eighty-two patients (84 lesions) with LRM+ after EMR (n = 45) or ESD (n = 39) were enrolled. Forty patients underwent additional gastrectomy or ESD, and 44 were closely observed. The residual/recurrent tumor rate was 34.5 % (29 of 84 lesions). Univariate analysis found that the residual/recurrent tumor was associated with the endoscopic resection type (EMR), undifferentiated histology, number of involved directions, rate of lateral resection margin involvement and the total length (mm) of the lateral resection margin involved by the tumor. In multivariate logistic regression analysis, undifferentiated histology and rate (%) were independent risk factors (odds ratio [OR] 5.28, 95 % confidence interval [CI] 1.13–24.72, p = 0.035 and OR 1.08, 95 % CI 1.03–1.14, p = 0.004, respectively). Clinicopathological factors that were identified from the univariate and multivariate analyses were scored in order to predict residual/recurrent tumors.
Conclusion
We suggest a scoring system for additional treatment in patients with LRM+ after endoscopic resection of EGC based on the development of residual/recurrent tumors. This scoring system enables a more detailed selection of cases and may be useful in determining further treatment.
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References
Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225
Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T (2006) A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 9:262–270
Takenaka R, Kawahara Y, Okada H, Hori K, Inoue M, Kawano S (2008) Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointest Endosc 68:887–894
Jang JS, Choi SR, Qureshi W, Kim MC, Kim SJ, Jeung JS (2009) Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea. Scand J Gastroenterol 44:1315–1322
Lee JH, Kim JH, Kim DH, Jeon TY, Kim DH, Kim GH (2010) Is surgical treatment necessary after non-curative endoscopic resection for early gastric cancer? J Gastric Cancer 10:182–187
Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58:331–336
Isomoto H, Ohnita K, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H (2010) Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 22:311–317
Jung H, Bae JM, Choi MG, Noh JH, Sohn TS, Kim S (2011) Surgical outcome after incomplete endoscopic submucosal dissection of gastric cancer. Br J Surg 98:73–78
Yoon H, Kim SG, Choi J, Im JP, Kim JS, Kim WH (2013) Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer. Surg Endosc 27:1561–1568
Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229
Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5:1–5
Soetikno R, Kaltenbach T, Yeh R, Gotoda T (2005) Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 23:4490–4498
Japanese Gastric Cancer A (1998) Japanese Classification of Gastric Carcinoma—2nd English Edition. Gastric Cancer 1:10–24
Nakamura Y, Yasuoka H, Tsujimoto M, Kurozumi K, Nakahara M, Nakao K (2006) Importance of lymph vessels in gastric cancer: a prognostic indicator in general and a predictor for lymph node metastasis in early stage cancer. J Clin Pathol 59:77–82
Park JC, Lee SK, Seo JH, Kim YJ, Chung H, Shin SK (2010) Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience. Surg Endosc 24:2842–2849
Kakushima N, Ono H, Tanaka M, Takizawa K, Yamaguchi Y, Matsubayashi H (2011) Factors related to lateral margin positivity for cancer in gastric specimens of endoscopic submucosal dissection. Dig Endosc 23:227–232
Seto Y, Shimoyama S, Kitayama J, Mafune K, Kaminishi M, Aikou T (2001) Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer. Gastric Cancer 4:34–38
Abe N, Watanabe T, Suzuki K, Machida H, Toda H, Nakaya Y (2002) Risk factors predictive of lymph node metastasis in depressed early gastric cancer. Am J Surg 183:168–172
Ajani JA, Bentrem DJ, Besh S, D’Amico TA, Das P, Denlinger C (2013) Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw 11:531–546
Bae SY, Jang TH, Min BH, Lee JH, Rhee PL, Rhee JC (2012) Early additional endoscopic submucosal dissection in patients with positive lateral resection margins after initial endoscopic submucosal dissection for early gastric cancer. Gastrointest Endosc 75:432–436
Kikuchi D, Iizuka T, Hoteya S, Yamada A, Furuhata T, Yamashita S (2012) Safety and efficacy of secondary endoscopic submucosal dissection for residual gastric carcinoma after primary endoscopic submucosal dissection. Digestion 86:288–293
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Jae Jin Hwang, Kwung Jun Park, Young Soo Park, Hye Seung Lee, Hyuk Yoon, Cheol Min Shin, Nayoung Kim, Dong Ho Lee have disclosed no financial relationships relevant to this publication.
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Jae Jin Hwang and Kwung Jun Park are contributed equally to this work.
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Hwang, J.J., Park, K.J., Park, Y.S. et al. A scoring system for patients with a tumor-positive lateral resection margin after endoscopic resection of early gastric cancer. Surg Endosc 30, 2751–2758 (2016). https://doi.org/10.1007/s00464-015-4543-9
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DOI: https://doi.org/10.1007/s00464-015-4543-9