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

Sunagawa, Hiroki; Kinoshita, Takahiro; Kaito, Akio; Shibasaki, Hidehito; Kaneko, Kazuhiro; Ochiai, Atsushi; Ohtsu, Atsushi; Nishida, Toshirou

doi:10.1007/s00595-016-1353-1

Cited by 41 publications

(49 citation statements)

References 23 publications

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“…In addition, LNM do not appear in many patients who undergo gastrectomy for deep submucosal invasive EGC, the rate of which is estimated to be 7.2–27.3% [8-13]. Despite these findings, the risk factors (RFs) for LNM in patients who undergo ER for deep submucosal invasive EGC has not been fully understood because the previous reports about such patients are single-institution studies with a small number of cases.…”

Section: Introductionmentioning

confidence: 81%

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Miyahara¹,

Hatta

Nakagawa³

et al. 2018

Digestion

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Background/Aims: The role of an undifferentiated component in submucosal invasion and submucosal invasion depth (SID) for lymph node metastasis (LNM) of early gastric cancer (EGC) with deep submucosal invasion (SID ≥500 μm from the muscularis mucosa) after endoscopic submucosal dissection (ESD) has not been fully understood. This study aimed to clarify the risk factors (RFs), including these factors, for LNM in such patients. Methods: We enrolled 513 patients who underwent radical surgery after ESD for EGC with deep submucosal invasion. We evaluated RFs for LNM, including an undifferentiated component in submucosal invasion and the SID, which was subdivided into 500–999, 1,000–1,499, 1,500–1,999, and ≥2,000 µm. Results: LNM was detected in 7.6% of patients. Multivariate analysis revealed that an undifferentiated component in submucosal invasion (OR 2.22), in addition to tumor size >30 mm (OR 2.51) and lymphatic invasion (OR 3.07), were the independent RFs for LNM. However, the SID was not significantly associated with LNM. Conclusion: An undifferentiated component in submucosal invasion was one of the RFs for LNM, in contrast to SID, in patients who underwent ESD for EGC with deep submucosal invasion. This insight would be helpful in managing such patients.

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Section: Introductionmentioning

confidence: 81%

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Miyahara¹,

Hatta

Nakagawa³

et al. 2018

Digestion

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“…In this category, until JGCA guidelines version 4, additional surgery was recommended for all patients as a result of the potential risk of LNM. However, the rate of LNM in such patients was only 5.2%–11.0% . Thus, this recommendation may have been excessive.…”

Section: Management After Er In Each Curability Categorymentioning

confidence: 98%

“…However, the rate of LNM in such patients was only 5.2%-11.0%. 38,[47][48][49][50][51][52][53][54][55][56][57][58][59][60] Thus, this recommendation may have been excessive. In the JGCA guidelines version 5, 13 the statement for the management of eCura C-2 was changed as follows: "Additional surgery is the standard treatment method, but clinicians should decide considering the patient's physical condition."…”

Section: Ecura C-2mentioning

confidence: 99%

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

Hatta

Gotoda

Koike

et al. 2019

Digestive Endoscopy

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Japanese guidelines for gastric cancer treatment were first published in 2001 for the purpose of showing the appropriate indication for each treatment method, thereby reducing differences in the therapeutic approach among institutions, and so on. With the accumulation of evidence and the development and prevalence of endoscopic submucosal dissection (ESD), the criteria for the indication and curability of endoscopic resection (ER) for early gastric cancer (EGC) have expanded. However, several problems still remain. Although a risk-scoring system (eCura system) for predicting lymph node metastasis (LNM) may help treatment decision in patients who do not meet the curative criteria for ER of EGC, which is referred to as eCura C-2 in the latest guidelines, additional gastrectomy with lymphadenectomy may be excessive for many patients, even those at high risk for LNM. Less-invasive function-preserving surgery, such as non-exposed endoscopic wall-inversion surgery with laparoscopic sentinel node sampling, may overcome this problem. In addition, further less-invasive treatment, such as ER with chemotherapy, should be established for patients who prefer not to undergo additional gastrectomy. CONCEPT AND UPDATE OF THE JAPANESE GUIDELINESJ APANESE GASTRIC CANCER Association (JGCA) guidelines were first published in 2001 9 for the purpose of: (i) showing the appropriate indication of each treatment method for gastric cancer; (ii) reducing differences in the therapeutic approach among institutions; (iii) improving the safety and outcome of treatment for gastric cancer; (iv) reducing the personnel and economic burden by avoiding unnecessary treatment; and (v) improving mutual understanding between medical staff and patients. With the accumulation of evidence, the guidelines were updated in

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“…The rate of LNM in patients who underwent additional surgery after noncurative resection of ER for EGC is reported to be 5.2% to 11.0%. 53,54,[57][58][59][60][61][63][64][65][66][67][68][69][70] Most reports are from Korea and Japan, and only one study has been reported from Western countries. 53 In this study, LNM after noncurative resection was shown in 8.3% of the patients (1/12), 53 which is similar to the rate of LNM (8.5%) in the largest study from Japan.…”

Section: Lnm In Patients With Additional Surgery After Noncurative Rementioning

confidence: 99%

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

et al. 2020

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Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established. (Gut Liver 2020;14:412-422 ) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

Abstract: 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.

Cited by 41 publications

References 23 publications

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

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