Risk stratification and management of non-curative resection after endoscopic submucosal dissection for early gastric cancer
- 686 Downloads
Non-curative resection after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) can contribute to local recurrence or lymphatic and distant metastasis of the tumor. We stratified the risk of local recurrence according to the histological characteristics in non-curative resection after ESD for EGC.
Among 892 EGCs treated with ESD, 152 (17.0 %) were classified as non-curative resection based on the histology after ESD. The clinical outcomes and risk factors associated with local recurrence were analyzed retrospectively in non-curative resections.
Of 152 non-curative resections, 46 (30.3 %) were stratified as Group 1 (incomplete resection and met the ESD criteria), 31 (20.4 %) as Group 2 (complete resection and exceeded the ESD criteria), 41 (27.0 %) as Group 3 (incomplete resection and exceeded the ESD criteria), and 34 (22.4 %) as Group 4 (lymphovascular invasion regardless of complete resection). Group 3 [odds ratio (OR) 3.991; p = 0.015] and Group 4 (OR 4.487; p = 0.014) had higher rates of local recurrence after non-curative resection. In those high-risk groups, endoscopic surveillance without additional treatment detected significantly more local recurrence than in those receiving additional treatment (p = 0.029).
Risk stratification for non-curative resection is important for EGC prognosis after ESD. Moreover, additional treatment for non-curative resection influences long-term outcomes, especially in high-risk groups.
KeywordsNon-curative resection Early gastric cancer Endoscopic submucosal dissection
This work was supported in part by the Soonchunhyang University Research Fund.
Drs. Jae Pil Han, Su Jin Hong, Hee Kyung Kim, Yun Nah Lee, Tae Hee Lee, Bong Min Ko and Joo Young Cho have no conflict of interest or financial relationships relevant to this publication.
- 7.Okada K, Fujisaki J, Kasuga A, Omae M, Yoshimoto K, Hirasawa T, Ishiyama A, Yamamoto Y, Tsuchida T, Hoshino E, Igarashi M, Takahashi H (2011) Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection. Surg Endosc 25:841–848PubMedCrossRefGoogle Scholar
- 8.Kim GH, Parkdo Y, Kida M, Kim DH, Jeon TY, Kang HJ, Kim DU, Choi CW, Lee BE, Heo J, Song GA (2010) Accuracy of high-frequency catheter-based endoscopic ultrasonography according to the indications for endoscopic treatment of early gastric cancer. J Gastroenterol Hepatol 25:506–511PubMedCrossRefGoogle Scholar
- 13.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
- 17.Tanabe S, Ishido K, Higuchi K, Sasaki T, Katada C, Azuma M, Naruke A, Kim M, Koizumi W (2014) Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center. Gastric Cancer 17:130–136PubMedCrossRefGoogle Scholar
- 21.Shim CN, Kim H, Kim DW, Chung HS, Park JC, Lee H, Shin SK, Lee SK, Lee YC (2014) Clinicopathologic factors and outcomes of histologic discrepancy between differentiated and undifferentiated types after endoscopic resection of early gastric cancer. Surg Endosc 28(7):2097–2105PubMedCrossRefGoogle Scholar
- 24.Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, Omae M, Kubota M, Ishiyama A, Hirasawa T, Chino A, Inamori M, Yamamoto Y, Yamamoto N, Tsuchida T, Tamegai Y, Nakajima A, Hoshino E, Igarashi M (2012) Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy 44:122–127PubMedCrossRefGoogle Scholar
- 25.Kim YY, Jeon SW, Kim J, Park JC, Cho KB, Park KS, Kim E, Chung YJ, Kwon JG, Jung JT, Kim EY, Kim KO, Jang B, Lee SH, Yang CH (2013) Endoscopic submucosal dissection for early gastric cancer with undifferentiated histology: could we extend the criteria beyond? Surg Endosc 27:4656–4662PubMedCrossRefGoogle Scholar