A case of lymph node metastasis following a curative endoscopic submucosal dissection of an early gastric cancer

Oya, Hisaharu; Gotoda, Takuji; Kinjo, Tetsu; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Taniguchi, Hirokazu; Kushima, Ryoji; Saka, Makoto; Katai, Hitoshi; Oda, Ichiro

doi:10.1007/s10120-011-0111-8

Cited by 30 publications

(24 citation statements)

References 12 publications

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“…Oda et al [14] reported a multicenter questionnaire study on long-term outcomes of curative ESD resection for expanded indication in 1,289 patients with EGC. In this study, the percentages of lymph nodes or distant metastasis with more than 5-year follow up was 0.15 % in intramucosal differentiated-type cancers [2 cm in size without ulceration (1/708; 95 % CI, 0.004-0.84 %), 0 % in intramucosal differentiated-type cancers B3 cm in size with ulceration (0/305; 95 % CI, 0-1.26 %), 0 % in intramucosal undifferentiated-type cancer 2 cm in size without ulceration (0/58; 95 % CI, 0-6.38 %), and 1.0 % in SM1 differentiated-type cancers B3 cm in size (2/218; 95 % CI, 0.12-3.55 %: one of the two cases is this case and the other was published by Oya et al [13]). This retrospective study also indicated the slightly higher 95 % CI upper limits in SM1 differentiated-type cancers B3 cm than those in differentiated-type intramucosal gastric cancers, except for the small number of undifferentiated-type intramucosal EGC.…”

Section: Case Reportmentioning

confidence: 68%

“…Oya et al [13] reported another case of regional lymph node metastasis 49 months after ESD in a patient with SM1 gastric cancer that fulfilled the expanded criteria. The patient's ESD was actually a noncurative resection based on the current version of the treatment guidelines because of a poorly differentiated component with ulceration [3].…”

Section: Case Reportmentioning

confidence: 99%

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A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer

et al. 2014

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Currently in Japan, differentiated-type gastric submucosal invasive cancers \500 lm with negative lymphovascular involvement are included in expanded pathological criteria for curative endoscopic treatment. This categorization is based on a retrospective examination of surgical resection cases in which patients suitable for such expanded criteria were determined to have a negligible risk of lymph node metastasis. We performed endoscopic submucosal dissection on a 66-year-old man with early gastric cancer in June 2004, and pathology revealed a well-differentiated adenocarcinoma, 16 9 8 mm in size, minute submucosal invasion depth (100 lm), and negative lymphovascular invasion or ulceration as well as tumorfree margins, so the case was diagnosed as a curative resection. In this case, however, local recurrence and distant metastasis resulted in August 2011. The patient received systemic chemotherapy but died of gastric cancer 23 months after recurrence.

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Section: Case Reportmentioning

confidence: 68%

Section: Case Reportmentioning

confidence: 99%

A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer

et al. 2014

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“…In addition, local recurrence and regional or distant LN metastasis remain critical issues. In this study, two patients in whom curative ESD was achieved for SM1 [19,20]. Therefore, more careful attention must be paid, in particular, to patients with SM1 invasive EGC lesions for which curative ESD has been achieved.…”

Section: Discussionmentioning

confidence: 94%

“…The primary lesions in the two patients were SM1 invasive cancers. The patient who developed regional LN metastasis underwent salvage surgery, and no [19]. The other patient who developed distant LN metastasis with local recurrence received systemic chemotherapy but died of gastric cancer about 2 years after recurrence [20].…”

Section: Long-term Outcomesmentioning

confidence: 99%

High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

et al. 2015

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Background Endoscopic submucosal dissection (ESD) has been used to treat patients with early gastric cancers (EGCs), including large and ulcerative lesions. Few published data exist on the long-term outcomes of this treatment with median follow-up periods of over 5 years; we therefore aimed to assess the long-term outcomes of EGC patients undergoing ESD. Methods A total of 1,956 consecutive patients with 2,210 EGC lesions at initial onset underwent ESD with curative intent at our hospital from 1999 to 2006. We performed a retrospective analysis of the 5-year survival of EGC patients undergoing curative ESD for absolute indications or for expanded indications. Results For the pathological curability, curative ESD for absolute indications, curative ESD for expanded indications of differentiated-type EGC, and curative ESD for undifferentiated-type EGC were achieved in 781, 713, and 43 patients, respectively. The median follow-up period was 83.3 months. Among the 1,537 patients, there were only two patients with recurrence, including one who developed a regional lymph node (LN) metastasis and one who developed a distant LN metastasis with local recurrence resulting in gastric cancer-related death. Seven died from metachronous gastric cancers. The 5-year rates of overall survival, disease-specific survival, and relative survival were 92.6, 99.9, and 105.0 %, respectively.Conclusions Based on the high rate of 5-year survival among EGC patients undergoing curative ESD for absolute indications or for expanded indications in the largest patient series with a median follow-up period of over 5 years, ESD could be employed as a standard treatment for EGC lesions.

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“…A number of studies have reported a favorable prognosis after curative resection of EGC by endoscopic resection [5][6][7][8]. Although the 5-year overall survival and 5-year disease-specific survival rates of patients with EGC after curative therapy are more than 97% and 99% respectively [7][8][9], there have been several reports of EGC recurrence after curative treatment, which can lead to unfavorable outcomes [8,10,11]. After curative endoscopic resection, the recurrence rate ranges from 4.5% to 16%.…”

Section: Introductionmentioning

confidence: 99%

Pattern of extragastric recurrence and the role of abdominal computed tomography in surveillance after endoscopic resection of early gastric cancer: Korean experiences

et al. 2017

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Background Although extragastric recurrence after endoscopic resection of early gastric cancer is rare, it is important because of its potentially fatal outcomes. We investigated the patterns of extragastric recurrence after endoscopic resection and evaluated the role of abdominal computed tomography in surveillance. Methods Between July 1994 and June 2014, 4915 patients underwent endoscopic resection of early gastric cancer. Because of follow-up periods of less than 6 months and consecutive surgery within 1 year, 810 patients were excluded. Thus, 4105 patients were retrospectively reviewed. Results The median follow-up period was 37 months (interquartile range 20-59.6 months). The overall incidence of extragastric recurrence was 0.37% (n = 15). In patients who underwent curative resection, the incidence was 0.14% (n = 5). There were three recurrences in the absolute indication group, six in the expanded indication group, and six in the beyond expanded indication group. The median time to extragastric recurrence was 17 months (interquartile range 16.5-43.2 months). Of the 15 extragastric recurrences, 11 were in the regional lymph nodes and 4 were in the liver, adrenal gland, and peritoneum. Sixty percent (9/15) of the extragastric recurrences occurred without intragastric lesions. Eleven recurrences were detected by abdominal computed tomography, and eight patients underwent curative surgery. Conclusions After endoscopic resection of early gastric cancer, regional lymph node recurrence is the predominant extragastric recurrence pattern, which can be detected via abdominal computed tomography and cured by rescue surgery. Abdominal computed tomography should be considered as a surveillance method, especially in patients with an expanded indication.

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A case of lymph node metastasis following a curative endoscopic submucosal dissection of an early gastric cancer

Cited by 30 publications

References 12 publications

A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer

A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer

High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

Pattern of extragastric recurrence and the role of abdominal computed tomography in surveillance after endoscopic resection of early gastric cancer: Korean experiences

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