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Outcomes of ESD for patients with early gastric cancer and comorbid liver cirrhosis: a propensity score analysis

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Abstract

Background

Gastric cancer and liver cirrhosis (LC) are often comorbid. However, little is known about the clinical outcomes of gastric endoscopic submucosal dissection (ESD) in patients with comorbid LC.

Methods

This case–control study used a multicentre retrospective cohort. We identified 69 LC patients from the cohort of patients with early gastric cancer, who underwent gastric ESD at 12 hospitals from March 2003 to November 2010. Using the propensity score matching method, 69 patients without LC were used to compare the short- and long-term outcomes of ESD.

Results

Among the 69 LC patients, 53 (77 %) were Child-Pugh grade A (CP-A) and 16 (28 %) had past or present histories of hepatocellular carcinoma (HCC). Short-term outcomes did not differ between the LC patients and controls or between the CP-A and CP-B/C patients. Although the LC patients had significantly worse long-term outcomes than the controls (the 5-year overall survival rates were 60 vs. 91 %, respectively), patients with CP-A liver function without HCC histories had an overall survival almost equivalent to that of patients without LC (controls).

Conclusions

LC patients appear to be good candidates for ESD if they have CP-A liver function and no history of HCC. Although their short-term outcomes were not inferior, the patients with Child-Pugh grades B/C or with histories of HCC benefited less from ESD.

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Abbreviations

EGC:

Early gastric cancer

ER:

Endoscopic resection

QOL:

Quality of life

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

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Disclosure

Drs. Kato, Nishida, Hamasaki, Kawai, Yoshio, Egawa, Yamamoto, Ogiyama, Komori, Nakahara, Yabuta, Nishihara, Yamaguchi, Yamada, Hayashi, Iijima, Michida, Tsujii, and Takehara have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Motohiko Kato, Tsutomu Nishida, Yoshito Hayashi, Takuya Yamada & Tetsuo Takehara

  2. Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Shinjuku-ku, Japan

    Motohiko Kato

  3. Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Osaka, Japan

    Toshimitsu Hamasaki

  4. Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan

    Naoki Kawai

  5. Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Suita, Japan

    Toshiyuki Yoshio & Takuya Yamada

  6. Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan

    Satoshi Egawa

  7. Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan

    Katsumi Yamamoto

  8. Department of Gastroenterology, Itami City Hospital, Itami, Japan

    Hideharu Ogiyama

  9. Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan

    Masato Komori

  10. Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan

    Masanori Nakahara

  11. Department of Gastroenterology, Sakai Municipal Hospital, Sakai, Japan

    Takamasa Yabuta

  12. Department of Gastroenterology, Minoh City Hospital, Minoh, Japan

    Akihiro Nishihara

Authors
  1. Motohiko Kato
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  2. Tsutomu Nishida
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  3. Toshimitsu Hamasaki
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  4. Naoki Kawai
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  5. Toshiyuki Yoshio
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  6. Satoshi Egawa
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  7. Katsumi Yamamoto
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  8. Hideharu Ogiyama
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  9. Masato Komori
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  10. Masanori Nakahara
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  11. Takamasa Yabuta
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  12. Akihiro Nishihara
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  13. Yoshito Hayashi
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  14. Takuya Yamada
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  15. Tetsuo Takehara
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Corresponding author

Correspondence to Motohiko Kato.

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Kato, M., Nishida, T., Hamasaki, T. et al. Outcomes of ESD for patients with early gastric cancer and comorbid liver cirrhosis: a propensity score analysis. Surg Endosc 29, 1560–1566 (2015). https://doi.org/10.1007/s00464-014-3841-y

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  • DOI: https://doi.org/10.1007/s00464-014-3841-y

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