Background and Aims
We aimed to evaluate long-term outcomes with noncurative endoscopic submucosal dissection
(ESD) for early gastric cancer (EGC) and surveillance strategies such as the optimal
time for additional endoscopic treatment in patients with noncurative ESD.
Methods
Of 2527 patients who underwent gastric ESD for EGC, 512 (20.3%) patients with noncurative
resection were reviewed. Noncurative resection is defined as positive resected margins
on histology, lymphovascular infiltration, or beyond the expanded criteria for ESD.
Results
The mean ± standard deviation follow-up duration was 79.0 ± 55.7 months. A total of
264 patients (51.6%) and 50 patients (9.8%) underwent surgery and endoscopic treatment
after noncurative resection, respectively, whereas 198 patients (38.7%) were observed.
Cancer-specific survival and disease-free survival rates were significantly different
among the surgery, other endoscopic treatment, and observation groups (96.7%, 86.8%,
and 86.2%, respectively; P =.030; and 92.5%, 73.6%, and 63.0%, respectively; P < .001). When patients who underwent surgery were excluded, the disease-free survival
rate of recurrence was not significantly different between the endoscopic treatment
and observation groups (73.6% vs 63.0%; P = .548). To exclude the potential for the presence of lymph node metastasis, we further
analyzed disease-free survival of local recurrence by comparing the patients with
only a positive lateral resection margin. The disease-free survival rate was higher
in the endoscopic treatment group than in the observation group (89.2% vs 69.1%; P = .023). Moreover, additional endoscopic treatment within 3 months showed significant
associations with lower risk of local recurrence on multivariate analysis (hazard
ratio, 0.017; 95% confidence interval, 0.002-0.260; P = .003).
Conclusions
In patients with noncurative ESD, additional surgery showed a better long-term outcome;
moreover, when a positive lateral resection margin was the only noncurative factor,
additional endoscopic treatment within 3 months could be considered to improve disease-free
survival.
Abbreviations:
APC (argon plasma coagulation), ASA (American Society of Anesthesiologists), AUC (area under the curve), CI (confidence interval), DFS (disease-free survival), EGC (early gastric cancer), ER (endoscopic resection), ESD (endoscopic submucosal dissection), HR (hazard ratio), LVI (lymphovascular infiltration), SM (submucosal)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: October 13, 2017
Accepted:
October 4,
2017
Received:
May 1,
2017
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Park at [email protected] .
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
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