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Long-term oncological outcomes of submucosal manipulation during non-curative endoscopic submucosal dissection for submucosal invasive gastric cancer: a multicenter retrospective study in Japan

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Abstract

Background

Sufficient information is not available on the extent to which lymph node metastasis (LNM) and prognosis are affected by submucosal manipulation during endoscopic submucosal dissection (ESD) for submucosal invasive gastric cancer (SMGC). We aimed to identify the effects of submucosal manipulation during ESD on LNM and prognosis in patients with SMGC.

Methods

From 19 institutions in Japan, 2526 patients who failed to meet the current curative criteria for ESD between 2000 and 2011 were recruited. After exclusion, 1969 patients were remained. Based on the treatment strategy after ESD, 1064 patients underwent additional radical surgery. A total of 890 of 1064 patients with SMGC, LNM and cancer recurrence, and prognosis were retrospectively reviewed.

Results

The median follow-up duration was 67 months. A total of 214 patients had SM1 (depth of tumor invasion from the muscularis mucosae <500 μm) invasive cancer and 676 patients had SM2 (depth of tumor invasion from the muscularis mucosae ≥500 μm) invasive cancer. LNM was found in 84 patients (9.4%), and 14 patients (1.6%) developed cancer recurrence. The 3-year and 5-year overall survival rates were 96.1 and 91.7%, respectively. The 3-year and 5-year disease-specific survival rates were 99.3 and 98.5%, respectively.

Conclusions

The rates of LNM and cancer recurrence, and prognosis of patients who underwent additional radical surgery after non-curative ESD for SMGC were excellent. Submucosal manipulation during ESD for SMGC does not seem to enhance the risk for LNM or worsen the prognosis compared to surgical series.

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Acknowledgements

We thank Hiroyuki Ono (Division of Endoscopy, Shizuoka Cancer Center), Naohiko Harada (Department of Gastroenterology, National Hospital Organization Kyushu Medical Center), Yasumasa Hara (Department of Internal Medicine, Toyama Prefectural Central Hospital), and Kohei Yamanouchi (Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School) for the enrollment of patients and data collection. Finally, we thank Motoki Ohyauchi (Department of Gastroenterology, Osaki Citizen Hospital), and Tomoyuki Koike (Department of Gastroenterology, Tohoku University Graduate School of Medicine) for their insightful comments.

Author’s contribution

Hirotaka Ito, Takuji Gotoda: planning and conducting the study; Hirotaka Ito, Noboru Kawata, Akiko Takahashi, Yoshikazu Yoshifuku, Shu Hoteya, Masahiro Nakagawa, Waku Hatta, Masaaki Hirano, Mitsuru Esaki, Mitsuru Matsuda, Ken Ohnita, Ryo Shimoda, Motoyuki Yoshida, Osamu Dohi, Jun Takeda, KeikoTanaka, Shinya Yamada, Tsuyotoshi Tsuji, Yoshiaki Hayashi: collecting data; Hirotaka Ito, Takuji Gotoda, Waku Hatta, Naoki Nakaya, Tomohiro Nakamura: interpreting data; Hirotaka Ito: drafting the manuscript; Takuji Gotoda, Tsuneo Oyama, Waku Hatta, Tomohiro Nakamura, Tooru Shimosegawa: critical revision of the manuscript; Tomohiro Nakamura: statistical analysis; Takuji Gotoda, Tsuneo Oyama, Tooru Shimosegawa: study supervision. All authors listed have contributed substantially to the design, data collection and analysis, and editing of the manuscript. The final version of the manuscript was approved by all authors.

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Authors and Affiliations

  1. Department of Gastroenterology, Osaki Citizen Hospital, 3-8-1 Honami, Furukawa, Osaki, Miyagi, 989-6183, Japan

    Hirotaka Ito

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan

    Takuji Gotoda

  3. Division of Endoscopy, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 385-0051, Japan

    Tsuneo Oyama & Akiko Takahashi

  4. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Noboru Kawata

  5. Department of Gastroenterology and Metabolism, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan

    Yoshikazu Yoshifuku

  6. Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Shu Hoteya

  7. Department of Endoscopy, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan

    Masahiro Nakagawa

  8. Department of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Waku Hatta & Tooru Shimosegawa

  9. Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu, Niigata, 943-0192, Japan

    Masaaki Hirano

  10. Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan

    Mitsuru Esaki

  11. Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan

    Mitsuru Matsuda

  12. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 952-8501, Japan

    Ken Ohnita

  13. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan

    Ryo Shimoda

  14. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan

    Motoyuki Yoshida

  15. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan

    Osamu Dohi

  16. Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan

    Jun Takada

  17. Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Keiko Tanaka

  18. Department of Gastroenterology and Hepatology, Japanese Red Cross Society, Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, Kyoto, 605-0981, Japan

    Shinya Yamada

  19. Department of Gastroenterology, Akita City Hospital, 4-30 Matsuoka-machi, Kawamoto, Akita, Akita, 010-0933, Japan

    Tsuyotoshi Tsuji

  20. Division of Gastroenterology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, Fukui, 910-8526, Japan

    Yoshiaki Hayashi

  21. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan

    Naoki Nakaya & Tomohiro Nakamura

Authors
  1. Hirotaka Ito
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  2. Takuji Gotoda
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  3. Tsuneo Oyama
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  4. Noboru Kawata
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  5. Akiko Takahashi
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  6. Yoshikazu Yoshifuku
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  7. Shu Hoteya
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  10. Masaaki Hirano
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  11. Mitsuru Esaki
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  12. Mitsuru Matsuda
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  13. Ken Ohnita
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  14. Ryo Shimoda
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  15. Motoyuki Yoshida
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  16. Osamu Dohi
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  17. Jun Takada
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  18. Keiko Tanaka
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  19. Shinya Yamada
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  20. Tsuyotoshi Tsuji
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  21. Yoshiaki Hayashi
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  22. Naoki Nakaya
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  23. Tomohiro Nakamura
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  24. Tooru Shimosegawa
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Corresponding authors

Correspondence to Hirotaka Ito or Takuji Gotoda.

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Disclosures

Drs. Hirotaka Ito, Takuji Gotoda, Tsuneo Oyama, Noboru Kawata, Akiko Takahashi, Yoshikazu Yoshifuku, Shu Hoteya, Masahiro Nakagawa, Waku Hatta, Masaaki Hirano, Mitsuru Esaki, Mitsuru Matsuda, Ken Ohnita, Ryo Shimoda, Motoyuki Yoshida, Osamu Dohi, Jun Tanaka, Keiko Tanaka, Shinya Yamada, Tsuyotoshi Tsuji, Yoshiaki Hayashi, Naoki Nakaya, Tomohiro Nakamura, and Tooru Shimosegawa have no conflicts of interest or financial ties to disclose.

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Ito, H., Gotoda, T., Oyama, T. et al. Long-term oncological outcomes of submucosal manipulation during non-curative endoscopic submucosal dissection for submucosal invasive gastric cancer: a multicenter retrospective study in Japan. Surg Endosc 32, 196–203 (2018). https://doi.org/10.1007/s00464-017-5659-x

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