Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms

Abstract

Background: With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients. Methods: A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People's Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed. Results: A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type ( P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type ( P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0–9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006). Conclusions: The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms.

Metachronous lesions after gastric endoscopic submucosal dissection: first assessment of the FAMISH prediction score

“…Previous studies showed that up to 96% of MGL were amenable to ER [10,14,[17][18][19][20] or, less frequently, to surgical resection [10,14,[17][18][19][20]. This supports the recommendation of tight (annual) and long-term endoscopic surveillance to ensure early detection of MGL [3-5, 14, 16, 19, 21].…”

“…The median time to metachronous lesions of 30 months outlines the importance of endoscopic surveillance in the first 3 years after ESD. The current guidelines do not define the extent of surveillance, and the longest intervals described in previous studies for MGL detection were 8.3 and 9.7 years [15,17]. Given the high cumulative rate of MGL, endoscopic surveillance is probably of benefit beyond 5 years after ESD [5,8,19,20], but a one-size-fits-all approach can be challenged.…”

“…As ESD is a minimally invasive and gastric mucosa-sparing technique, the MGL incidence after ESD is significantly higher than that for gastrectomy (0.9 %–3.0 %) 4 14 15 16 . Previous studies showed that up to 96 % of MGLs were amenable to endoscopic resection 10 14 17 18 19 20 or, less frequently, to surgical resection 10 14 17 18 19 20 . This supports the recommendation of short (annual) and long-term endoscopic surveillance to ensure early detection of MGL 3 4 5 14 16 19 21 .…”

Preoperative <i>H. pylori</i> Eradication Therapy Facilitates Precise Delineation in Early Gastric Cancer with Current <i>H. pylori</i> Infection

“…However, this is too lenient for evaluating lesions of HpC-EGC patients with an average diameter <2 cm. In this case, we adopted "precise delineation" in this 2 Precise delineation: when D min of a lesion was >5 mm, it would be absolutely ensured with negative horizontal margins and regarded as safe. 3 D min : D is referred to the distance between marking dots and the PDL (when the PDL was inside marking dots, D was recorded as a positive value; otherwise, it was recorded as 0 mm), and D min was the shortest one of all marking dots in all slices of one en bloc-resected lesion.…”

“…Early gastric cancer (EGC) is defined as gastric adenocarcinoma limited to the mucosa or submucosa of the stomach, regardless of lymph node status [1]. Endoscopic submucosal dissection (ESD) has been proven to perform curative resection for EGC in cases with a low risk of lymph node metastasis, achieving equivalent effectiveness with structural integrity compared to surgery [2][3][4][5]. In this process, complete resection is essential for the operation's curability, including negative horizontal resection margins [6].…”