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Survival benefits of additional surgery after non-curative endoscopic resection in patients with early gastric cancer: a meta-analysis

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Abstract

Background

The survival benefit of additional surgery after non-curative endoscopic resection of early gastric cancer is a matter of debate. This meta-analysis is intended to draw a convincing conclusion on this issue based on data currently available.

Methods

A systematic review of PubMed/Medline database was performed from 2010 to 2018 for studies comparing survival outcomes of additional surgery versus simple follow-up after non-curative endoscopic resection for early gastric cancer. Differences between groups were calculated using either the fixed effects model or random effects model.

Results

Ten retrospective studies with 4225 patients met the inclusion criteria. Additional surgery significantly provided better 5 years overall survival [odds ratios (OR) 3.50, 95% confidence interval (95% CI) 2.89–4.24] and disease-specific survival (OR 3.99, 95% CI 2.50–6.36).

Conclusions

Additional surgery offers survival benefits to patients undergoing non-curative endoscopic resection of early gastric cancer.

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References

  1. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123

    Article  Google Scholar 

  2. Kusano C, Iwasaki M, Kaltenbach T, Conlin A, Oda I, Gotoda T (2011) Should elderly patients undergo additional surgery after non-curative endoscopic resection for early gastric cancer? Long-term comparative outcomes. Am J Gastroenterol 106:1064–1069. https://doi.org/10.1038/ajg.2011.49

    Article  PubMed  Google Scholar 

  3. Kim ER, Lee H, Min BH, Lee JH, Rhee PL, Kim JJ, Kim KM, Kim S (2015) Effect of rescue surgery after non-curative endoscopic resection of early gastric cancer. Br J Surg 102:1394–1401. https://doi.org/10.1002/bjs.9873

    Article  CAS  PubMed  Google Scholar 

  4. Yang HJ, Kim SG, Lim JH, Choi J, Im JP, Kim JS, Kim WH, Jung HC (2015) Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer. Surg Endosc 29:1145–1155. https://doi.org/10.1007/s00464-014-3780-7

    Article  PubMed  Google Scholar 

  5. Hoteya S, Iizuka T, Kikuchi D, Ogawa O, Mitani T, Matsui A, Furuhata T, Yamashita S, Yamada A, Kaise M (2016) Clinicopathological outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection. Digestion 93:53–58. https://doi.org/10.1159/000441758

    Article  CAS  PubMed  Google Scholar 

  6. Yamanouchi K, Ogata S, Sakata Y, Tsuruoka N, Shimoda R, Nakayama A, Akutagawa T, Shirai S, Takeshita E, Yamamoto K, Fujimoto K, Iwakiri R (2016) Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer. Endosc Int Open 4:E24–E29. https://doi.org/10.1055/s-0034-1393124

    Article  PubMed  Google Scholar 

  7. Eom BW, Kim YI, Kim KH, Yoon HM, Cho SJ, Lee JY, Kim CG, Kook MC, Kim YW, Nam BH, Ryu KW, Choi IJ (2017) Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer. Gastrointest Endosc 85:155–163.e3. https://doi.org/10.1016/j.gie.2016.07.036

    Article  PubMed  Google Scholar 

  8. Kawata N, Kakushima N, Takizawa K, Tanaka M, Makuuchi R, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Sugino T, Kusafuka K, Shimoda T, Nakajima T, Terashima M, Ono H (2017) Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection. Surg Endosc 31:1607–1616. https://doi.org/10.1007/s00464-016-5148-7

    Article  PubMed  Google Scholar 

  9. Pyo JH, Lee H, Min BH, Lee JH, Kim KM, Yoo H, Ahn S, An JY, Choi MG, Lee JH, Sohn TS, Bae JM, Kim JJ, Kim S (2017) Comparison of long-term outcomes after non-curative endoscopic resection in older patients with early gastric cancer. Ann Surg Oncol 24:2624–2631. https://doi.org/10.1245/s10434-017-5888-1

    Article  PubMed  Google Scholar 

  10. Suzuki H, Oda I, Abe S, Sekiguchi M, Nonaka S, Yoshinaga S, Saito Y, Fukagawa T, Katai H (2017) Clinical outcomes of early gastric cancer patients after noncurative endoscopic submucosal dissection in a large consecutive patient series. Gastric Cancer 20:679–689. https://doi.org/10.1007/s10120-016-0651-z

    Article  PubMed  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  13. Suzuki S, Gotoda T, Hatta W, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Shimosegawa T (2017) Survival benefit of additional surgery after non-curative endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis. Ann Surg Oncol 24:3353–3360. https://doi.org/10.1245/s10434-017-6039-4

    Article  PubMed  Google Scholar 

  14. Toya Y, Endo M, Nakamura S, Akasaka R, Kosaka T, Yanai S, Kawasaki K, Koeda K, Sugai T, Matsumoto T (2017) Clinical outcomes of non-curative endoscopic submucosal dissection with negative resected margins for gastric cancer. Gastrointest Endosc 85:1218–1224. https://doi.org/10.1016/j.gie.2016.11.018

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Nakaya N, Nakamura T, Shimosegawa T (2017) A scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer: “eCura system”. Am J Gastroenterol 112:874–881. https://doi.org/10.1038/ajg.2017.95

    Article  PubMed  Google Scholar 

  17. Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Nakamura T, Nakaya N, Shimosegawa T (2018) Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study. Gastric Cancer 21:481–489. https://doi.org/10.1007/s10120-017-0769-7

    Article  CAS  PubMed  Google Scholar 

  18. Fukunaga S, Nagami Y, Shiba M, Ominami M, Tanigawa T, Yamagami H, Tanaka H, Muguruma K, Watanabe T, Tominaga K, Fujiwara Y, Ohira M, Hirakawa K, Arakawa T (2017) Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis. Gastrointest Endosc 85:143–152. https://doi.org/10.1016/j.gie.2016.06.049

    Article  PubMed  Google Scholar 

  19. Meng FS, Zhang ZH, Wang YM, Lu L, Zhu JZ, Ji F (2016) Comparison of endoscopic resection and gastrectomy for the treatment of early gastric cancer: a meta-analysis. Surg Endosc 30:3673–3683. https://doi.org/10.1007/s00464-015-4681-0

    Article  PubMed  Google Scholar 

  20. Abe N, Gotoda T, Hirasawa T, Hoteya S, Ishido K, Ida Y, Imaeda H, Ishii E, Kokawa A, Kusano C, Maehata T, Ono S, Takeuchi H, Sugiyama M, Takahashi S (2012) Multicenter study of the long-term outcomes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older. Gastric Cancer 15:70–75. https://doi.org/10.1007/s10120-011-0067-8

    Article  PubMed  Google Scholar 

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Author notes

  1. Debang Li and Haixin Luan have contributed equally to this work.

Authors and Affiliations

  1. Department III of General Surgery, First Hospital of Lanzhou University, Lanzhou, China

    Debang Li

  2. Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, Fujian, China

    Haixin Luan, Shijie Wang & Yanming Zhou

Authors
  1. Debang Li
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  2. Haixin Luan
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  3. Shijie Wang
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  4. Yanming Zhou
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Corresponding author

Correspondence to Yanming Zhou.

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Disclosures

Debang Li, Haixin Luan, Shijie Wang, and Yanming Zhou have no conflicts of interest or financial ties to disclose.

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Li, D., Luan, H., Wang, S. et al. Survival benefits of additional surgery after non-curative endoscopic resection in patients with early gastric cancer: a meta-analysis. Surg Endosc 33, 711–716 (2019). https://doi.org/10.1007/s00464-018-6570-9

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  • DOI: https://doi.org/10.1007/s00464-018-6570-9

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