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Decision to perform additional surgery after non-curative endoscopic submucosal dissection for gastric cancer based on the risk of lymph node metastasis: a long-term follow-up study

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Abstract

Background

Radical surgery after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) may be excessive, since only 5–10% of patients have lymph node metastasis (LNM). This study investigated the suitability of the eCura system for determining the need for radical surgery after non-curative ESD.

Methods

We retrospectively investigated 343 patients who underwent non-curative ESD for EGC from 2006 to 2021 at a tertiary hospital in Korea. These patients were divided into surgery (n = 191) and observation (n = 152) groups based on whether they underwent additional surgery post-ESD. Each group was further classified into low-risk (eCura score 0–1), intermediate-risk (eCura score 2–4) and high-risk (eCura score 5–7). All patients were regularly followed-up at least annually after the initial treatment. The cumulative overall and recurrence-free survival rates were calculated for each category and compared between the surgery and observation groups.

Results

No significant differences in overall survival were found between the surgery and observation groups in low-risk (p = 0.168) and intermediate-risk patients (p = 0.306); however, high-risk patients had better 5-year overall survival rate in the surgery group than in the follow-up group (95.2% vs. 71.4%, p < 0.001). The 5-year recurrence-free survival rate was higher in the surgery group than in the observation group for low-risk (100% vs. 84.3%; p = 0.034), intermediate-risk (96.1% vs. 88.4%; p = 0.081) and high-risk patients (100% vs. 83.3%; p = 0.023).

Conclusions

Follow-up without additional surgery after non-curative ESD can be a reasonable option for low-risk and even intermediate-risk patients according to the eCura system. However, surgery is warranted for eCura high-risk patients.

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Funding

This study was supported by grants from the National Research Foundation of Korea (#NRF-2022R1A2B5B01001430) and by the Korean Research Corporation for Helicobacter and Microbiome (KRAHM-20221001).

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Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Seunghan Lee, Sang Gyun Kim & Soo-Jeong Cho

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  1. Seunghan Lee
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  2. Sang Gyun Kim
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Contributions

SL contributed to data acquisition, statistical analysis and interpretation of data, and drafting of the manuscript; SGK contributed to material support and critical revision of the manuscript for important intellectual content; S-JC contributed to study concept and design, critical revision of the manuscript for important intellectual content, obtaining funding, and study supervision.

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Correspondence to Soo-Jeong Cho.

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Seunghan Lee, Sang Gyun Kim and Soo-Jeong Cho have no conflicts of interest or financial ties to disclose.

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Lee, S., Kim, S.G. & Cho, SJ. Decision to perform additional surgery after non-curative endoscopic submucosal dissection for gastric cancer based on the risk of lymph node metastasis: a long-term follow-up study. Surg Endosc 37, 7738–7748 (2023). https://doi.org/10.1007/s00464-023-10324-2

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