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Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases

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Abstract

Purpose

Endoscopic submucosal dissection is recommended for early gastric cancer with a low risk of lymph node metastasis. When the pathological findings do not meet the curative criteria; then, an additional gastrectomy with lymph node dissection is recommended. However, most cases have neither lymph node metastasis nor a local residual tumor during an additional surgery.

Methods

This was a single-institutional retrospective cohort study, analyzing 200 patients who underwent an additional gastrectomy after non-curative endoscopic submucosal dissection from January 2005 to October 2015. We reviewed the patients’ clinicopathological data and evaluated the predictors for the presence of a residual tumor.

Results

Histopathology revealed lymph node metastasis in 15 patients (7.5 %) and a local residual tumor in 23 (11.5 %). A multivariable analysis revealed macroscopic findings (flat/elevated type) (p = 0.011, odds ratio = 4.63), lymphatic invasion (p < 0.0001, odds ratio = 14.2), and vascular invasion (p = 0.04, odds ratio = 4.00) to be predictors for lymph node metastasis. A positive vertical margin (p = 0.0027, odds ratio = 3.26) and horizontal margin (p = 0.0008, odds ratio = 5.74) were predictors for a local residual tumor. All cases with lymph node metastasis had lymphovascular invasion with at least one other non-curative factor.

Conclusions

The risk of a residual tumor can, therefore, be estimated based on the histopathology of endoscopic submucosal dissection samples. Lymphovascular invasion appears to be a pivotal predictor of lymph node metastasis.

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References

  1. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.

    Article  PubMed  Google Scholar 

  2. Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymphnode metastasis and the feasibility of endoscopic resection for undifferentiated-typeearly gastric cancer. Gastric Cancer. 2009;12:148–52.

    Article  PubMed  Google Scholar 

  3. Association Japanese Gastric Cancer. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

    Article  Google Scholar 

  4. Association Japanese Gastric Cancer. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.

    Article  Google Scholar 

  5. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  6. Toyokawa T, Ohira M, Tanaka H, Minamino H, Sakurai K, Nagami Y, et al. Optimal management for patients not meeting the inclusion criteria after endoscopic submucosal dissection for gastric cancer. Surg Endosc. 2015. doi:10.1007/s00464-015-4491-4.

    Google Scholar 

  7. Son SY, Park JY, Ryu KW, Eom BW, Yoon HM, Cho SJ, et al. The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection: is the minimal lymph node dissection applicable? A retrospective study. Surg Endosc. 2013;27:3247–53.

    Article  PubMed  Google Scholar 

  8. Jung H, Bae JM, Choi MG, Noh JH, Sohn TS, Kim S. Surgical outcome after incomplete endoscopic submucosal dissection of gastric cancer. Br J Surg. 2011;98:73–8.

    Article  CAS  PubMed  Google Scholar 

  9. Lee JH, Kim JH, Kim DH, Jeon TY, Kim DH, Kim GH, et al. Is surgical treatment necessary after non-curative endoscopic resection for early gastric cancer? J Gastric Cancer. 2010;10:182–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Song KY, Hyung WJ, Kim HH, Han SU, Cho GS, Ryu SW, et al. Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multi-center study. J Surg Oncol. 2008;98:6–10.

    Article  PubMed  Google Scholar 

  11. Ito H, Inoue H, Ikeda H, Odaka N, Yoshida A, Satodate H, et al. Surgical outcomes and clinicopathological characteristics of patients who underwent potentially noncurative endoscopic resection for gastric cancer: a report of a single-center experience. Gastroenterology Research and Practice. 2013. doi:10.1155/2013/427405.

    PubMed  PubMed Central  Google Scholar 

  12. Yoon H, Kim SG, Choi J, Im JP, Kim JS, Kim WH, et al. Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer. Surg Endosc. 2013;27:1561–8.

    Article  PubMed  Google Scholar 

  13. Kim TK, Kim GH, Park do Y, Lee BE, Jeon TY, Kim DH, et al. Risk factors for local recurrence in patients with positive lateral resection margins after endoscopic submucosal dissection for early gastric cancer. Surg Endosc. 2015;29:2891–8.

    Article  PubMed  Google Scholar 

  14. Numata N, Oka S, Tanaka S, Kagemoto K, Sanomura Y, Yoshida S, et al. Risk factors and management of positive horizontal margin in early gastric cancer resected by en bloc endoscopic submucosal dissection. Gastric Cancer. 2015;18:332–8.

    Article  PubMed  Google Scholar 

  15. Nonoka S, Oda I, Makazu M, Haruyama S, Abe S, Suzuki H, et al. Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy. Gasstroint Endosc. 2013;78:63–72.

    Article  Google Scholar 

  16. Ojima T, Takifuji K, Nakamura M, Nakamori M, Katsuda M, Iida T, et al. Endoscopic submucosal dissection for gastric tumors in various types of remnant stomach. Endoscopy. 2014;46:645–9.

    Article  PubMed  Google Scholar 

  17. Ojima T, Takifuji K, Nakamura M, Nakamori M, Yamaue H. Long-term survival of patients with endoscopic submucosal dissection for remnant gastric cancers. Surg Laparosc Endo Percutaneous Techn. 2016;26:78–81.

    Article  Google Scholar 

  18. Kim JY, Kim YY, Kim SJ, Park JC, Kwon YH, Jung MK, et al. Predictive factors for lymph node metastasis in signet ring cell gastric cancer and the feasibility of endoscopic submucosal dissection. J Gastric Cancer. 2013;13:93–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kim DJ, Kim W. A case of single lymph node metastasis near the common hepatic artery following a curative endoscopic resection for gastric mucosal cancer. Gastric Cancer. 2014;17:387–91.

    Article  PubMed  Google Scholar 

  20. Lee IS, Yook JH, Park YS, Kim KC, Oh ST, Kim BS. Suitability of endoscopic submucosal dissection for treatment of submucosal gastric cancers. Br J Surg. 2013;100:668–73.

    Article  CAS  PubMed  Google Scholar 

  21. Kusano C, Iwasaki M, Kaltenbach T, Conlin A, Oda I, Gotoda T. Should elderly patients undergo additional surgery after non-curative endoscopic resection for early gastric cancer? Long-term comparative outcomes. Am J Gastroenterol. 2011;106:1064–9.

    Article  PubMed  Google Scholar 

  22. Ahn JY, Jung HY, Choi JY, Kim MY, Lee JH, Choi KS, et al. Natural course of noncurative endoscopic resection of differentiated early gastric cancer. Endoscopy. 2012;44:1114–20.

    Article  CAS  PubMed  Google Scholar 

  23. Sekiguchi M, Kushima R, Oda I, Suzuki H, Taniguchi H, Sekine S, et al. Clinical significance of a papillary adenocarcinoma component in early gastric cancer: a single-center retrospective analysis of 628 surgically resected early gastric cancers. J Gastroenterol. 2015;50:424–34.

    Article  PubMed  Google Scholar 

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Correspondence to Takahiro Kinoshita.

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Sunagawa, H., Kinoshita, T., Kaito, A. et al. Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases. Surg Today 47, 202–209 (2017). https://doi.org/10.1007/s00595-016-1353-1

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  • DOI: https://doi.org/10.1007/s00595-016-1353-1

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