Abstract
Background
Gastric cancer treatment guidelines recommend additional surgery as the standard treatment for lesions for which endoscopic submucosal dissection (ESD) is not indicated. However, the incidence of lymph-node metastasis is low in most patients.
Methods and materials
The study comprised 231 patients (231 lesions) who underwent ESD for early gastric cancer (EGC) in our hospital from September 2002 through March 2015 and were found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after ESD. The patients were divided into the additional operation group and the follow-up group, and long-term outcomes were studied retrospectively. Risk factors for metastasis and recurrence were also studied (capture rate, 98.7%).
Results
The median follow-up was 48 months. There were 174 men and 57 women with a median age of 72 years. The additional operation group comprised 118 patients, and the follow-up group comprised 113 patients. The rates of 5-year cause-specific survival and 5-year overall survival were significantly higher in the additional operation group (100 and 96.0%, respectively) than in the follow-up group (92.6 and 73.3%, respectively; p = 0.010, p < 0.001). In the follow-up group, 5 patients (4.4%) died of gastric cancer (p = 0.021). Among elderly patients 75 years or older, long-term outcomes did not differ significantly between the groups. Sixteen patients had metastasis or recurrence, and the presence of lymphatic involvement was an independent risk factor for metastasis, recurrence, or both (p = 0.003; odds ratio 10.594; 95% confidence interval 2.294–48.927).
Conclusions
In patients with EGC who are confirmed to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after ESD, additional surgery should be aggressively performed if the patient can tolerate such treatment. In elderly patients aged 75 years or older and patients with serious underlying diseases, follow-up observation was suggested to be one option in patients who give informed consent after receiving an explanation of the risk of recurrence.
Similar content being viewed by others
Change history
07 December 2017
In Table 1, the second item in the right-hand column “Extra-indication” should be changed to “Out of indication”. The correct version of Table 1 is displayed.
References
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:359–386
Ono H, Yao K, Fujishiro M, Oda I, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, Ichinose M, Matsui T (2016) Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc 28:3–15
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver.4) Gastric cancer 2016 (Published online)
Nakata B, Tendo M, Okuyama M, Nakahara K, Ishizu H, Masuda G, Lee T, Hori T, Ohsawa M, Sato H, Ishikawa T (2016) Additional surgical resection after endoscopic mucosal dissection for early gastric cancer: a medium-sized hospital’s experience. Int J Surg 36:335–341
Gotoda T, Yanagisawa A, Sasako M, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225
Oda I, Gotoda T, Hamanaka H, Eguchi T, Saito Y, Matsuda T, Bhandari P, Emura F, Saito D, Ono H (2005) Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc 17:54–58
Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J, Kohno S (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58:331–336
Tanabe S, Ishido K, Matsumoto T, Kosaka T, Oda I, Suzuki H, Fujisaki J, Ono H, Kawata N, Oyama T, Takahashi A, Doyama H, Kobayashi M, Uedo N, Hamada K, Toyonaga T, Kawara F, Tanaka S, Yoshifuku Y (2017) Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: multicenter collaborative study. Gastric Cancer 20:45–52
Ishii S, Yamashita K, Kato H, Nishizawa N, Ushiku H, Mieno H, Moriya H, Hosoda K, Katada N, Kikuchi S, Tanabe S, Koizumi W, Saegusa M, Watanabe M (2016) Predictive factors for lymph node metastasis in additional gastrectomy after endoscopic resection of cT1aN0 gastric cancer. Surg Today 46:1031–1038
Kakushima N, Fujishiro M, Kodashima S, Muraki Y, Tateishi A, Yahagi N, Omata M (2007) Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population. J Gastroenterol Hepatol 22:311–314
Chinda D, Sasaki Y, Tatsuta T, Tsushima K, Wada T, Shimoyama T, Fukuda S (2015) Perioperative complications of endoscopic submucosal dissection for early gastric cancer in elderly Japanese patients 75 years of age or older. Intern Med 54:267–272
Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226
Ono H, Hasuike N, Inui T, Takizawa K, Ikehara H, Yamaguchi Y, Otake Y, Matsubayashi H (2008) Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer. Gastric Cancer 11:47–52
Hoteya S, Iizuka T, Kikuchi D, Ogawa O, Mitani T, Matsui A, Furuhata T, Yamashita S, Yamada A, Kaise M (2016) Clinicopathological outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection. Digestion 93:53–58
Kusano C, Iwasaki M, Kaltenbach T, Conlin A, Oda I, Gotoda T (2011) Should elderly patients undergo additional surgery after non-curative endoscopic resection for early gastric cancer? Long-term comparative outcomes. Am J Gastroenterol. 106:1064–1069
Centers for Disease Control and Prevention (2003) Public health and aging: trends in aging—United States and worldwide. JAMA 289:1371–1373
Fried L, Barron J (2005) Older adults. Handbook of urban health: populations, methods, and practice. Springer, New York
Sumiyoshi T, Kondo H, Fujii R, Minagawa T, Fujie S, Kimura T, Ihara H, Yoshizaki N, Hirayama M, Oyamada Y, Okushiba S (2017) Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older. Gastric Cancer 20:489–495
Fidler IJ (1995) Clitical factors in the biology of human cancer metastasis. Am Surg 61:1065–1066
Hoteya S, Yamashita S, Kikuchi D, Nakamura M, Fujimoto A, Matsui A, Nishida N, Mitani T, Kuroki Y, Iizuka T, Yahagi N (2011) Endoscopic submucosal dissection for submucosal invasive gastric cancer and curability criteria. Dig Endosc 23:30–36
Kim H, Kim JH, Park JC, Lee YC, Noh SH, Kim H (2011) Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers. Oncol Rep 25:1589–1595
Sunagawa H, Kinoshita T, Kaito A, Shibasaki H, Kaneko K, Ochiai A, Ohtsu A, Nishida T (2016) Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases. Surg Today 47:202–209
Fujii H, Ishii E, Tochitani S, Nakaji S, Hirata N, Kusanagi H, Narita M (2015) Lymph node metastasis after endoscopic submucosal dissection of a differentiated gastric cancer confined to the mucosa with an ulcer smaller than 30 mm. Dig Endosc 27:159–161
Sekiguchi M, Oda I, Taniguchi H, Suzuki H, Morita S, Fukagawa T, Sekine S, Kushima R, Katai H (2016) Risk stratification and predictive risk-scoring model for lymph node metastasis in early gastric cancer. J Gastroenterol 51:961–970
Funding
No research support was received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Authors Takafumi Yano, Kenji Ishido, Satoshi Tanabe, Takuya Wada, Mizutomo Azuma, Natsuko Kawanishi, Sakiko Yamane, Akinori Watanabe, Chikatoshi Katada, and Wasaburo Koizumi have no conflicts of interest or financial ties to disclose.
Informed consent
Informed consent was obtained from all patients in accordance with our institutional protocol.
Additional information
A correction to this article is available online at https://doi.org/10.1007/s00464-017-5953-7.
Rights and permissions
About this article
Cite this article
Yano, T., Ishido, K., Tanabe, S. et al. Long-term outcomes of patients with early gastric cancer found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after endoscopic submucosal dissection. Surg Endosc 32, 1314–1323 (2018). https://doi.org/10.1007/s00464-017-5809-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-017-5809-1