Abstract
Background
The incidence of metachronous lesions after endoscopic resection (ER) of high-grade dysplasia (HGD) has not been evaluated, and optimal surveillance strategy remains vague. This study aimed to evaluate the incidence and characteristics of metachronous tumors including HGD and early gastric cancer (EGC) arising after ER.
Patients
The medical records of 2779 patients with 2981 lesions (445 patients with HGD and 2334 patients with EGC) who underwent ER and surveillance endoscopy at Asan Medical Center between April 1999 and December 2011 were retrospectively reviewed, and clinicopathological features of metachronous tumors were analyzed.
Results
Ninety-six metachronous lesions (17 HGD and 79 EGC) occurred in 92 patients during median 42 months of follow-up period (range 26–58 months). The 5-year and 10-year overall cumulative incidences of metachronous tumors were 4.6 and 10.5 %, respectively, and were on steady rise up to 10 years. The 5- and 10-year cumulative incidences of metachronous lesions were 4.1 and 8.4 % in HGD group and 4.7 and 11.3 % in EGC group (P = 0.578), respectively. The size of metachronous tumors was significantly smaller than initial lesion (2.3 vs. 1.9 cm, P = 0.039). Lower third of the stomach was most frequent site for both initial and metachronous lesions (77.1 and 70.8 %, respectively) and age was the significant predicting factor for metachronous tumors.
Conclusions
Cumulative incidence of metachronous tumors after ER of HGD was comparable to the incidence after ER of EGC. Surveillance endoscopy can be considered at least for 10 years, with special attention on the lower third of the stomach.
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References
Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Nakajima T, Sekiguchi M, Mori G, Taniguchi H, Sekine S (2015) Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection. Endoscopy 47(12):1113–1118
Kato M, Nishida T, Yamamoto K, Hayashi S, Kitamura S, Yabuta T, Yoshio T, Nakamura T, Komori M, Kawai N, Nishihara A, Nakanishi F, Nakahara M, Ogiyama H, Kinoshita K, Yamada T, Iijima H, Tsujii M, Takehara T (2013) Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group. Gut 62(10):1425–1432
Kobayashi M, Narisawa R, Sato Y, Takeuchi M, Aoyagi Y (2010) Self-limiting risk of metachronous gastric cancers after endoscopic resection. Dig Endosc 22(3):169–173
Min BH, Kim ER, Kim KM, Park CK, Lee JH, Rhee PL, Kim JJ (2015) Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer. Endoscopy 47(9):784–793. doi:10.1055/s-0034-1392249
Nakajima T, Oda I, Gotoda T, Hamanaka H, Eguchi T, Yokoi C, Saito D (2006) Metachronous gastric cancers after endoscopic resection: How effective is annual endoscopic surveillance? Gastric Cancer 9(2):93–98
Nasu J, Endo H, Nishina T, Hirasaki S, Hyodo I (2005) Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection. Endoscopy 37(10):990–993
Correa P (1992) Human gastric carcinogenesis: a multistep and multifactorial process—first American Cancer Society award lecture on cancer epidemiology and prevention. Cancer Res 52(24):6735–6740
Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, Dixon MF, Fenoglio-Preiser CM, Fléjou JF, Geboes K, Hattori T, Hirota T, Itabashi M, Iwafuchi M, Iwashita A, Kim YI, Kirchner T, Klimpfinger M, Koike M, Lauwers GY, Lewin KJ, Oberhuber G, Offner F, Price AB, Rubio CA, Shimizu M, Shimoda T, Sipponen P, Solcia E, Stolte M, Watanabe H, Yamabe H (2000) The Vienna classification of gastrointestinal epithelial neoplasia. Gut 47(2):251–255
Rugge M, Correa P, Dixon MF, Hattori T, Leandro G, Lewin K, Riddell RH, Sipponen P, Watanabe H (2000) Gastric dysplasia: the Padova international classification. Am J Surg Pathol 24(2):167–176
Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd english edition. Gastric Cancer 14(2):101–112
Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma—2nd english edition. Gastric Cancer 1(1):10–24
Hamilton SR, Aaltonen LA (2000) World health organization classification of tumors. IARC Press, Lyon
Hosokawa O, Kaizaki Y, Watanabe K, Hattori M, Douden K, Hayashi H, Maeda S (2002) Endoscopic surveillance for gastric remnant cancer after early cancer surgery. Endoscopy 34(6):469–473. doi:10.1055/s-2002-32007
Takeda J, Toyonaga A, Koufuji K, Kodama I, Aoyagi K, Yano S, Ohta J, Shirozu K (1997) Early gastric cancer in the remnant stomach. Hepatogastroenterology 45(23):1907–1911
Bae SE, Jung H-Y, Kang J, Park YS, Baek S, Jung J-H, Choi JY, Kim M-Y, Ahn JY, Choi K-S (2014) Effect of Helicobacter pylori eradication on metachronous recurrence after endoscopic resection of gastric neoplasm. Am J Gastroenterol 109(1):60–67
Han JS, Jang JS, Choi SR, Kwon HC, Kim MC, Jeong JS, Kim SJ, Sohn YJ, Lee EJ (2011) A study of metachronous cancer after endoscopic resection of early gastric cancer. Scand J Gastroenterol 46(9):1099–1104
Esaki Y, Hirokawa K, Yamashiro M (1987) Multiple gastric cancers in the aged with special reference to intramucosal cancers. Cancer 59(3):560–565
Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, Terao S, Amagai K, Hayashi S, Asaka M (2008) Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 372(9636):392–397
Nakagawa S, Asaka M, Kato M, Nakamura T, Kato C, Fujioka T, Tatsuta M, Keida K, Terao S, Takahashi S (2006) Helicobacter pylori eradication and metachronous gastric cancer after endoscopic mucosal resection of early gastric cancer. Aliment Pharmacol Ther 24(s4):214–218
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Charles J. Cho, Ji Yong Ahn, Hwoon-Yong Jung, Kyoungwon Jung, Ha Young Oh, Hee Kyong Na, Kee Wook Jung, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim, and Seon-Ok Kim declare no conflict of interest or financial arrangements with anyone.
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Charles J. Cho and Ji Yong Ahn have contributed equally to this work.
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Cho, C.J., Ahn, J.Y., Jung, HY. et al. The incidence and locational predilection of metachronous tumors after endoscopic resection of high-grade dysplasia and early gastric cancer. Surg Endosc 31, 389–397 (2017). https://doi.org/10.1007/s00464-016-4985-8
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DOI: https://doi.org/10.1007/s00464-016-4985-8