Clinical outcomes of non-curative endoscopic submucosal dissection with negative resected margins for gastric cancer

Toya, Yosuke; Endo, Masaki; Nakamura, Shotaro; Akasaka, Risaburo; Kubo, Takashi; Yanai, Shunichi; Kawasaki, Keisuke; Koeda, Keisuke; Sugai, Tamotsu; Matsumoto, Takayuki

doi:10.1016/j.gie.2016.11.018

Cited by 38 publications

(47 citation statements)

References 19 publications

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“…Differentiated type mucosal adenocarcinomas less than 2 cm in size that show lymphovascular invasion are reported to have low risk of lymph node metastasis, in which case the need for additional surgical procedures is not clear. 160 Although some studies comparing surgical resection following non-curative resection vs. no surgery reported no additional benefits of additional surgery, [161][162][163] most retrospective studies have reported an increase in overall survival and disease-specific survival in patients who underwent surgical resection 158,159,[164][165][166][167] Furthermore, additional surgical resection following non-curative endoscopic resection has also been reported to increase survival among patients of advanced age. [168][169][170] Differentiated type adenocarcinoma with a positive horizontal resection margin that meet all the other criteria for curative resection following en bloc resection is associated with a low risk of lymph node metastasis.…”

Section: Statement G10: We Recommend Additional Endoscopic Managementmentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Section: Statement G10: We Recommend Additional Endoscopic Managementmentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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“…To date, several studies have reported the clinical outcomes of EGC cases after non-curative ESD [15][16][17][18][19]. However, only a few studies have reported the long-term outcomes with non-curative ESD in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection for gastric cancer in elderly patients aged ≥ 75 years

et al. 2018

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Background Little is known about the long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection (ESD) in elderly patients with early gastric cancer. Methods Clinicopathological findings and long-term outcomes were evaluated in 87 patients with early gastric cancer (EGC) aged ≥ 75 years who were treated with non-curative ESD. Prognostic factors for overall survival (OS) were analyzed with the Kaplan-Meier method and a Cox proportional hazards model. Results During the follow-up period, among 27 patients who died of any cause, only one patient died of gastric cancer. OS probabilities after 3 and 5 years were 89.7% and 79.3%, respectively. Univariate analyses revealed that Eastern Cooperative Oncology Group performance status 2-3, Charlson comorbidity index (CCI) ≥ 3, neutrophil/lymphocyte ratio ≥ 3.3, prognostic nutritional index < 44.8, distal tumor location and macroscopically depressed or flat configuration were associated with poor OS. Cox multivariate analysis revealed high CCI (≥ 3) to be an independent prognostic factor associated with OS (hazard ratio: 2.63, 95% confidence interval [CI] 1.06-6.49, P = 0.037). Conclusions CCI may be a useful parameter for decision-making regarding additional surgery for elderly patients with gastric cancer treated by non-curative ESD.

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“…According to the guidelines [9][10][11], radical surgery is recommended for all patients after ESD that does not meet the current curative criteria for EGC. However, no significant difference in CSS has been observed between patients with no additional treatment and those with radical surgery after ESD in any previous study [7,14,16]. Although our previous study revealed a statistically significant difference between the patient groups, this discrepancy was rather small [17].…”

Section: Discussionmentioning

confidence: 57%

“…Clinicians should provide this information for patients when those patients desire follow-up with no additional treatment after noncurative ESD for EGC. Meanwhile, previous studies have examined CT at a follow-up interval of 6-12 months in patients with no additional treatment after noncurative ESD [4,7,14,16,24]. Although further study is needed to establish an appropriate follow-up interval in such patients, scheduled surveillance at intervals of at least 6 months by CT may be needed.…”

Section: Discussionmentioning

confidence: 99%

“…However, only 5-10% of these patients develop LNM [3,4,7,8,[12][13][14][15], and the merits of radical surgery for such patients remain unclear. Previous studies have revealed that cancer-specific survival (CSS) does not significantly differ between patients who are followed up but receive no additional treatment and those who undergo radical surgery after noncurative endoscopic submucosal dissection (ESD) [7,14,16]. However, these findings were only described in single-institution studies or studies with a relatively small number of patients.…”

Section: Introductionmentioning

confidence: 99%

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Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study

et al. 2017

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Clinical outcomes of non-curative endoscopic submucosal dissection with negative resected margins for gastric cancer

Cited by 38 publications

References 19 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection for gastric cancer in elderly patients aged ≥ 75 years

Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study

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