Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection

Watanabe, Kenichiro; Ogata, Shinichi; Kawazoe, Seiji; Watanabe, Kiichi; Kõyama, T.; Kajiwara, Tetsuro; Shimoda, Yudai; Takase, Yukinori; Irie, Kouji; Mizuguchi, Masanobu; Tsunada, Seiji; Iwakiri, Ryuichi; Fujimoto, Kazuma

doi:10.1016/j.gie.2005.08.049

Cited by 201 publications

(183 citation statements)

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“…The major advantage of ESD is the ability to resect large and ulcerative lesions en bloc, and the rate of en bloc complete resection is higher than that of EMR [6,8]. En bloc resection facilitates the correct pathological evaluation of lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, we gradually switched to EAM because the procedure is straightforward and enables the resection of larger specimens than does strip biopsy [4]. However, conventional procedures for EMR such as EAM have a risk of recurrence because of incomplete resection when piecemeal EMR is used to resect larger lesions [8]. We consequently started to perform ESD in April 2003 because Cumulative overall survival curves after exclusion of deaths from causes unrelated to gastric cancer of its higher rate of complete en bloc resection.…”

Section: Discussionmentioning

confidence: 99%

“…The advent of ESD has expanded the indication range for endoscopic resection [7]. Although ESD is technically challenging and can cause complications such as perforation, it has been reported to have a higher rate of en bloc resection than conventional EMR [8]. We previously reported that piecemeal resection has a slightly higher recurrence rate than en bloc resection in patients who undergo EMR for early gastric cancer [9].…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

et al. 2013

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Background Few studies have compared the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in patients with early gastric cancer. Methods We studied 780 lesions for which endoscopic treatment was indicated according to the Japanese Gastric Cancer Association (JGCA) criteria or the Results The median follow-up was 73 months in the EAM group and 65 months in the ESD group. Overall, the local recurrence rate was significantly lower in the ESD group (0.2 %, 1/421) than in the EAM group (4.2 %, 15/359) (p \ 0.05). For lesions meeting the JGCA criteria, the local recurrence rate was 2.9 % in the EAM group and 0 % in the ESD group (p \ 0.05). For lesions meeting the NCC criteria, the local recurrence rate was 12.5 % in the EAM group and 0.6 % in the ESD group (p \ 0.05). There was no significant difference between the groups in overall survival. Conclusions On long-term follow-up, ESD was associated with a lower rate of local recurrence than EAM for lesions that met the JGCA or the NCC criteria. From the point of view of radical curability, ESD can be recommended for the management of lesions that meet either set of criteria.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

et al. 2013

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“…Especially, endoscopic submucosal dissection (ESD) allows en bloc resection with tumor-free margins, even in cases with large and ulcerative lesions [1,2]. According to previous reports, the complete en bloc resection rate of ESD was over 80 %, which was significantly higher than that of conventional endoscopic mucosal resection [3]. Despite its convenience, there is a major concern about the high rate of newly developed neoplasms after endoscopic resection in the remaining gastric mucosa.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms

et al. 2014

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Background Despite many advantages, the development of synchronous or metachronous neoplasm is one of the main concerns with endoscopic resection. We aimed to clarify the independent risk factors for synchronous or metachronous gastric neoplasm. Methods We retrospectively reviewed the medical records of all patients who had undergone endoscopic resection for gastric high-grade dysplasia or early gastric cancer between April 2001 and February 2011. Results Among 971 subjects, 56 synchronous neoplasms and 42 metachronous neoplasms developed during 12-131 months of follow-up. In univariate analysis, age over 65 years, male gender, absence of Helicobacter pylori infection, lower third location, mucosal atrophy, and intestinal metaplasia were related to multiple gastric neoplasms. In multivariate analysis, absence of H. pylori infection [odds ratio (OR) 1.610, 95 % confidence interval (CI) 1.038-2.497)], lower third location (OR 1.704, 95 % CI 1.070-2.713), and intestinal metaplasia (OR 4.461, 95 % CI 1.382-14.401) were independent risk factors for multiple gastric neoplasms. For synchronous neoplasm, primary tumor size less than 1 cm was the only independent risk factor. For metachronous neoplasm, absence of H. pylori infection (OR 2.416, 95 % CI 1.214-4.810) was found to be the only independent risk factor. H. pylori eradication was found to be unrelated to the development of metachronous gastric neoplasms. Conclusions For tumors located in the antrum and accompanied by intestinal metaplasia, meticulous endoscopic evaluation with close follow-up after endoscopic resection is recommended.

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“…Recently, many reports showed the superiority of endoscopic submucosal dissection (ESD) compared with endoscopic mucosal resection in terms of higher en bloc and complete resection rate [94][95][96] , and this new technique and the advance of devices allowed to extend the indication of endoscopic resection, which included mucosal cancer without ulcerative findings regardless of tumor size or mucosal cancer with ulcerative findings less than 3 cm, or submucosal invasive cancer (less than 500 μm from the muscularis mucosae) less than 3 cm [97][98][99][100] .…”

Section: Endoscopic Surgery For Gastric Cancermentioning

confidence: 99%

Minimally Invasive Surgery of Gastric Cancer

Güner

Hyung

2017

Minimally Invasive Surgery for Upper Abdominal Cancer

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Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short-and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Gastric cancer; Minimally invasive surgery; Laparoscopic gastrectomyCore tip: Minimally invasive surgery has become an alternative modality for the treatment of gastric cancer.Son SY, Kim HH. Minimally invasive surgery in gastric cancer. World J Gastroenterol 2014; 20(39): 14132-14141 Available from: URL: http://www.wjgnet.com/1007-9327/full/ v20/i39/14132.htm DOI: http://dx.doi.org/10.3748/wjg.v20. tano et al [9] and Nagai et al [10] reported the success of laparoscopy-assisted distal gastrectomy (LADG) for EGC in 1994 and 1995. In the early 2000s, robot-assisted surgery emerged as one of the treatment modalities for EGC, and the first robot-assisted gastrectomy (RAG) for EGC was reported by Hashizume et al [11] in 2003. In 2011, singleincision laparoscopic surgery was described for EGC [12] . MIS has revolutionized the surgical approach to gastric cancer for the past two decades, leading to improvements in patients' quality of life by producing less pain, less blood loss, earlier postoperative recovery, and a shorter hospital stay [13][14][15][16][17][18][19] .Currently, MIS is evolving in two major directions [20] . First, MIS techniques are being used in more radical but less invasive procedures, such as totally laparoscopic distal gastrectomy or laparoscopic total gastrectomy with D1+ or D2 lymphadenectomy. These procedures are comparable to conventional open surgery and can be performed even in patients with advanced gastric cancer (AGC) [21][22][23] . Second, MIS is being employed for function-preserving surgery, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy, and limited gastrectomy with sentinel node navigation surgery. These procedures can assist in improving patients' late postoperative function and quality of life [20,[24][25][26] . RECENT ADVANCES IN LAPAROSCOPIC GASTRECTOMYAs advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Totally laparoscopic gastrectomy (TLG) is one example. TLG has gained popularity since Kanaya et al [27] reported the first delta-shaped anastomosis. A recent meta-analysis (five studies, 652 patients) showed that totally laparoscopic distal gastrectomy has less bleeding, shorter time to first flatus, and lower rates of postoperative complicat...

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Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection

Cited by 201 publications

References 36 publications

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms

Minimally Invasive Surgery of Gastric Cancer

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