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

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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.

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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.

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Authors and Affiliations

  1. Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea

    Jae Pil Han, Su Jin Hong, Yun Nah Lee, Tae Hee Lee, Bong Min Ko & Joo Young Cho

  2. Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea

    Hee Kyung Kim

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  1. Jae Pil Han
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  2. Su Jin Hong
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  3. Hee Kyung Kim
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  4. Yun Nah Lee
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Correspondence to Su Jin Hong.

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Han, J.P., Hong, S.J., Kim, H.K. et al. Risk stratification and management of non-curative resection after endoscopic submucosal dissection for early gastric cancer. Surg Endosc 30, 184–189 (2016). https://doi.org/10.1007/s00464-015-4180-3

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  • DOI: https://doi.org/10.1007/s00464-015-4180-3

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