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
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Natural course of noncurative endoscopic resection of differentiated early gastric cancer.Endoscopy. 2012; 44: 1114-1120
- Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer.Gastric Cancer. 2009; 12: 148-152
- Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study.Gut. 2009; 58: 331-336
- Risk of recurrent gastric cancer after endoscopic resection with a positive lateral margin.Endoscopy. 2014; 46: 273-278
- Favorable long-term outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection.Endoscopy. 2013; 45: 708-713
- Additive treatment improves survival in elderly patients after noncurative endoscopic resection for early gastric cancer.Surg Endosc. 2017; 31: 1376-1382
- Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications.Gastrointest Endosc. 2011; 74: 485-493
- New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points.Gastric Cancer. 2011; 14: 97-100
- Early additional endoscopic submucosal dissection in patients with positive lateral resection margins after initial endoscopic submucosal dissection for early gastric cancer.Gastrointest Endosc. 2012; 75: 432-436
- Treatment strategy after incomplete endoscopic resection of early gastric cancer.Clin Endosc. 2016; 49: 332-335
- Additive endoscopic resection may be sufficient for the patients with positive lateral margin after endoscopic resection of early gastric cancer.Gastrointest Endosc. 2017; 86: 849-856
- Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience.Surg Endosc. 2010; 24: 2842-2849
- Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer.Gastrointest Endosc. 2017; 85: 155-163.e3
- Safety and efficacy of secondary endoscopic submucosal dissection for residual gastric carcinoma after primary endoscopic submucosal dissection.Digestion. 2012; 86: 288-293
- American Society of Anesthesiologists Classification (ASA Class).StatPearls Publishing, Treasure Island, FL2017
- Endoscopic resection of early gastric cancer.Gastric Cancer. 2007; 10: 1-11
- Endoscopic submucosal dissection of early gastric cancer.J Gastroenterol. 2006; 41: 929-942
- Clinical outcomes of curative endoscopic submucosal dissection with negative resected margins for gastric cancer.Gastrointest Endosc. 2017; 85: 1218-1224
- Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection.Gastrointest Endosc. 2015; 81: 333-341.e1
- Risk stratification and management of non-curative resection after endoscopic submucosal dissection for early gastric cancer.Surg Endosc. 2016; 30: 184-189
- Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer.Endosc Int Open. 2016; 4: E24-E29
- Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection.Surg Endosc. 2013; 27: 1211-1218
- Ablation of residual gastric tumor by argon plasma coagulation after endoscopic resection.Surg Endosc. 2017; 31: 1093-1100
- Argon plasma coagulation for early gastric cancer: technique and outcome.Gastrointest Endosc. 2006; 63: 48-54
- Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD.Surg Endosc. 2017; 31: 1617-1626
- Histological verification of the usefulness of magnifying endoscopy with narrow-band imaging for horizontal margin diagnosis of differentiated-type early gastric cancers.Gastric Cancer. Epub. 2017 Jun 21;
- Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video).Gastrointest Endosc. 2011; 74: 1259-1267
- Probe-based confocal laser endomicroscopy in the margin delineation of early gastric cancer for endoscopic submucosal dissection.J Gastroenterol Hepatol. 2017; 32: 1046-1054
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
ScienceDirect
Access this article on ScienceDirectLinked Article
- Optimal interval of additional endoscopic re-intervention for noncurative cases via endoscopic submucosal dissectionGastrointestinal EndoscopyVol. 88Issue 6
