Non-curative endoscopic resection does not always lead to grave outcomes in submucosal invasive early gastric cancer
- 508 Downloads
- 14 Citations
Abstract
Background
Endoscopic submucosal dissection (ESD) has been widely performed for the treatment of early gastric cancer (EGC). The aim of this study is to examine the effectiveness of ESD in submucosal invasive gastric cancers (SM-GC), with a special focus on patients who underwent non-curative resection.
Methods
Data for 1,246 patients who underwent ESD for treatment of EGC at six medical centers in Daegu-Gyeongbuk, Korea, between February 2003 and May 2010 were collected. After retrospective analysis of ESD databases, 118 patients were enrolled and classified into three groups: (1) EGC with submucosal invasion less than 500 μm (SM1-GC) that met the expanded criteria (EC) (SM1 EC, n = 42); (2) SM1-GC that did not meet the EC (SM1 non-EC, n = 38); and (3) EGC with submucosal invasion greater than 500 μm (SM2-GC, n = 38).
Results
The en bloc and complete resection rates did not differ significantly among the three groups. However, the curative resection rate was significantly better in the SM1 EC group (69.0 %) compared to that in SM1 non-EC and SM2-GC groups (0 % in both cases). Out of a total of 118 patients, 89 (75.4 %) underwent non-curative resection, and cancer recurrence was observed in 9 (9/89, 10.1 %). We analyzed the survival rate in these non-curative patients and the overall survival and disease-free survival did not differ significantly between patients that were treated with additional surgical resection and those that were simply followed up after ESD.
Conclusions
Non-curative resection in SM-GC does not always lead to cancer recurrence. Thus, if additional surgery cannot be performed because of the patient’s unsuitable condition or refusal, a close follow-up with endoscopy can be considered as an alternative for carefully selected patients. Moreover, as the ESD technology continues to evolve, it might be possible to expand the criteria for curative ESD in patients with SM-GC.
Keywords
Early gastric cancer Endoscopic submucosal dissection Submucosal invasive gastric cancerNotes
Disclosures
Drs. Jun Young Choi, Seong Woo Jeon, Kwang Bum Cho, Kyung Sik Park, Eun Soo Kim, Chang Keun Park, Yun Jin Chung, Joong Goo Kwon, Jin Tae Jung, Eun Young Kim, Kyeong Ok Kim, Byung Ik Jang, Si Hyung Lee, Jeong Bae Park, Chang Hun Yang have no conflicts of interest or financial ties to disclose.
References
- 1.Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kanao H, Kawamura T, Yoshida S, Yoshihara M, Chayama K (2006) Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection. Endoscopy 38:996–1000PubMedCrossRefGoogle Scholar
- 2.Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883PubMedCrossRefGoogle Scholar
- 3.Soetikno R, Kaltenbach T, Yeh R, Gotoda T (2005) Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 23:4490–4498PubMedCrossRefGoogle Scholar
- 4.Takenaka R, Kawahara Y, Okada H, Hori K, Inoue M, Kawano S, Tanioka D, Tsuzuki T, Yagi S, Kato J, Uemura M, Ohara N, Yoshino T, Imagawa A, Fujiki S, Takata R, Yamamoto K (2008) Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointest Endosc 68:887–894PubMedCrossRefGoogle Scholar
- 5.Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11PubMedCrossRefGoogle Scholar
- 6.Onogawa S, Kitadai Y, Amioka T, Kodama M, Cho S, Kuroda T, Ochiumi T, Kimura S, Kuwai T, Tanaka S, Chayama K (2005) Expression of vascular endothelial growth factor (VEGF)-C and VEGF-D in early gastric carcinoma: correlation with clinicopathological parameters. Cancer Lett 226:85–90PubMedCrossRefGoogle Scholar
- 7.Park YD, Chung YJ, Chung HY, Yu W, Bae HI, Jeon SW, Cho CM, Tak WY, Kweon YO (2008) Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach. Endoscopy 40:7–10PubMedCrossRefGoogle Scholar
- 8.Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, Fujisaki J, Sano T, Yamaguchi T (2009) Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer 12:148–152PubMedCrossRefGoogle Scholar
- 9.Son HJ, Song SY, Kim S, Noh JH, Sohn TS, Kim DS, Rhee JC (2005) Characteristics of submucosal gastric carcinoma with lymph node metastatic disease. Histopathology 46:158–165PubMedCrossRefGoogle Scholar
- 10.Nonaka S, Oda I, Nakaya T, Kusano C, Suzuki H, Yoshinaga S, Fukagawa T, Katai H, Gotoda T (2011) Clinical impact of a strategy involving endoscopic submucosal dissection for early gastric cancer: determining the optimal pathway. Gastric Cancer 14:56–62PubMedCrossRefGoogle Scholar
- 11.Ishikawa S, Togashi A, Inoue M, Honda S, Nozawa F, Toyama E, Miyanari N, Tabira Y, Baba H (2007) Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type, depth of wall invasion, and lymph node metastasis. Gastric Cancer 10:35–38PubMedCrossRefGoogle Scholar
- 12.Nagano H, Ohyama S, Fukunaga T, Hiki N, Seto Y, Yamaguchi T, Kato Y, Yamaguchi A (2008) Two rare cases of node-positive differentiated gastric cancer despite their infiltration to sm1, their small size, and lack of lymphatic invasion into the submucosal layer. Gastric Cancer 11:53–57 discussion 57-58PubMedCrossRefGoogle Scholar
- 13.Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric cancer 14:113–123CrossRefGoogle Scholar
- 14.Sanomura Y, Oka S, Tanaka S, Noda I, Higashiyama M, Imagawa H, Shishido T, Yoshida S, Hiyama T, Arihiro K, Chayama K (2012) Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study. Gastric Cancer 15:97–105PubMedCrossRefGoogle Scholar
- 15.Goto O, Fujishiro M, Kodashima S, Ono S, Omata M (2009) Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 41:118–122PubMedCrossRefGoogle Scholar
- 16.Gotoda T, Iwasaki M, Kusano C, Seewald S, Oda I (2010) Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg 97:868–871PubMedCrossRefGoogle Scholar
- 17.Uedo N, Iishi H, Tatsuta M, Ishihara R, Higashino K, Takeuchi Y, Imanaka K, Yamada T, Yamamoto S, Yamamoto S, Tsukuma H, Ishiguro S (2006) Longterm outcomes after endoscopic mucosal resection for early gastric cancer. Gastric Cancer 9:88–92PubMedCrossRefGoogle Scholar
- 18.Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T, Doi T, Otani Y, Fujisaki J, Ajioka Y, Hamada T, Inoue H, Gotoda T, Yoshida S (2006) A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 9:262–270PubMedCrossRefGoogle Scholar
- 19.Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J, Kohno S (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58:331–336PubMedCrossRefGoogle Scholar
- 20.Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235PubMedCrossRefGoogle Scholar
- 21.Kang HJ, Kim DH, Jeon TY, Lee SH, Shin N, Chae SH, Kim GH, Song GA, Kim DH, Srivastava A, Park do Y, Lauwers GY (2010) Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection. Gastrointest Endosc 72:508–515PubMedCrossRefGoogle Scholar
- 22.Hoteya S, Yamashita S, Kikuchi D, Nakamura M, Fujimoto A, Matsui A, Nishida N, Mitani T, Kuroki Y, Iizuka T, Yahagi N (2011) Endoscopic submucosal dissection for submucosal invasive gastric cancer and curability criteria. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 23:30–36CrossRefGoogle Scholar