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Surgical Endoscopy

, Volume 30, Issue 1, pp 184–189 | Cite as

Risk stratification and management of non-curative resection after endoscopic submucosal dissection for early gastric cancer

  • Jae Pil Han
  • Su Jin HongEmail author
  • Hee Kyung Kim
  • Yun Nah Lee
  • Tae Hee Lee
  • Bong Min Ko
  • Joo Young Cho
Article
First Online:

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Non-curative resection Early gastric cancer Endoscopic submucosal dissection 
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Notes

Acknowledgments

This work was supported in part by the Soonchunhyang University Research Fund.

Disclosures

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.

References

  1. 1.
    Gotoda T (2005) A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 3:S71–S73PubMedCrossRefGoogle Scholar
  2. 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. 3.
    Lian J, Chen S, Zhang Y, Qiu F (2012) A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 76:763–770PubMedCrossRefGoogle Scholar
  4. 4.
    Araki Y, Sasaki Y, Hanabata N, Yoshimura T, Sawaya M, Hada R, Fukuda S (2011) Morphometry for microvessels in early gastric cancer by narrow band imaging-equipped magnifying endoscopy. Dig Endosc 23:233–239PubMedCrossRefGoogle Scholar
  5. 5.
    Lee JH, Cho JY, Choi MG, Kim JS, Choi KD, Lee YC, Jang JY, Chun HJ, Seol SY (2008) Usefulness of autofluorescence imaging for estimating the extent of gastric neoplastic lesions: a prospective multicenter study. Gut Liver 2:174–179PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Park JM, Ahn CW, Yi X, Hur H, Lee KM, Cho YK, Han SU (2011) Efficacy of endoscopic ultrasonography for prediction of tumor depth in gastric cancer. J Gastric Cancer 11:109–115PubMedPubMedCentralCrossRefGoogle Scholar
  7. 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. 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
  9. 9.
    Hirasawa K, Kokawa A, Oka H, Yahara S, Sasaki T, Nozawa A, Morimoto M, Numata K, Taguri M, Morita S, Maeda S, Tanaka K (2011) Risk assessment chart for curability of early gastric cancer with endoscopic submucosal dissection. Gastrointest Endosc 74:1268–1275PubMedCrossRefGoogle Scholar
  10. 10.
    Ryu KW, Choi IJ, Doh YW, Kook MC, Kim CG, Park HJ, Lee JH, Lee JS, Lee JY, Kim YW, Bae JM (2007) Surgical indication for non-curative endoscopic resection in early gastric cancer. Ann Surg Oncol 14:3428–3434PubMedCrossRefGoogle Scholar
  11. 11.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225PubMedCrossRefGoogle Scholar
  12. 12.
    Shimada Y (2004) JGCA (The Japan Gastric Cancer Association). Gastric cancer treatment guidelines. Jpn J Clin Oncol 34:58PubMedCrossRefGoogle Scholar
  13. 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
  14. 14.
    Isomoto H, Ohnita K, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Nakao K, Kohno S, Shikuwa S (2010) Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 22:311–317PubMedCrossRefGoogle Scholar
  15. 15.
    Kosaka T, Endo M, Toya Y, Abiko Y, Kudara N, Inomata M, Chiba T, Takikawa Y, Suzuki K, Sugai T (2013) Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Dig Endosc 26:183–191PubMedCrossRefGoogle Scholar
  16. 16.
    Choi MK, Kim GH, Park do Y, Song GA, Kim DU, Ryu DY, Lee BE, Cheong JH, Cho M (2013) Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience. Surg Endosc 27:4250–4258PubMedCrossRefGoogle Scholar
  17. 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
  18. 18.
    Oda I, Gotoda T, Sasako M, Sano T, Katai H, Fukagawa T, Shimoda T, Emura F, Saito D (2008) Treatment strategy after non-curative endoscopic resection of early gastric cancer. Br J Surg 95:1495–1500PubMedCrossRefGoogle Scholar
  19. 19.
    Ahn JY, Jung HY, Choi JY, Kim MY, Lee JH, Choi KS, Kim DH, Choi KD, Song HJ, Lee GH, Kim JH, Park YS (2012) Natural course of noncurative endoscopic resection of differentiated early gastric cancer. Endoscopy 44:1114–1120PubMedCrossRefGoogle Scholar
  20. 20.
    Heo J, Jeon SW (2013) The clinical significance and management of noncurative endoscopic resection in early gastric cancer. Clin Endosc 46:235–238PubMedPubMedCentralCrossRefGoogle Scholar
  21. 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
  22. 22.
    Park JS, Hong SJ, Han JP, Kang MS, Kim HK, Kwak JJ, Ko BM, Cho JY, Lee JS, Lee MS (2013) Early-stage gastric cancers represented as dysplasia in a previous forceps biopsy: the importance of clinical management. Dig Liver Dis 45:170–175PubMedCrossRefGoogle Scholar
  23. 23.
    Maekawa S, Takeo S, Ikejiri K, Anai H, Saku M (1995) Clinicopathological features of lymph node metastasis in early gastric cancer. Int Surg 80:200–203PubMedGoogle Scholar
  24. 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. 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
  26. 26.
    Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Odagaki T, Taniguchi H, Kushima R, Saito Y (2013) Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Endoscopy 45:703–707PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jae Pil Han
    • 1
  • Su Jin Hong
    • 1
    Email author
  • Hee Kyung Kim
    • 2
  • Yun Nah Lee
    • 1
  • Tae Hee Lee
    • 1
  • Bong Min Ko
    • 1
  • Joo Young Cho
    • 1
  1. 1.Digestive Disease Center and Research Institute, Department of Internal MedicineSoonchunhyang University College of MedicineBucheonKorea
  2. 2.Department of PathologySoonchunhyang University College of MedicineBucheonKorea

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