Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer

Abstract

Background and study aims: Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer (EGC) without lymph node metastasis. However, some patients undergo noncurative ESD. The aim of the present study was to assess the long-term clinical outcomes of noncurative ESD with or without additional surgery. Patients and methods: We investigated the chart data from all patients who had undergone ESD for EGC at Saga Medical School Hospital and Saga Prefectural Medical Centre Koseikan between 2001 and 2012. A total of 957 cases (1047 lesions) of EGC underwent ESD, and 99 had noncurative ESD. In total, 20 cases were excluded because their follow-up period was <?3 years. We divided the patients into observation and additional surgery groups, and we compared the survival rate and related factors between the groups. Results: After noncurative ESD, 28?/79 patients (35.4?%) underwent additional surgery and 51/79 (64.6?%) were followed up without surgery. The average age of patients in the observation group was higher than that of the additional surgery group (75.9 vs. 71.6 years; P?=?0.03). The incidence of hypertension was significantly higher in the observation group compared with the additional surgery group (51.0 vs. 25.9?%; P?=?0.03). The overall survival rate of the additional surgery group was longer than that of the observation group.?However, only one patient died from gastric cancer in the observation group.?The disease-specific survival rate did not differ significantly between the groups. Conclusions: It might be acceptable to follow up without additional surgery for some patients with comorbidity and who were elderly after noncurative ESD for EGC.

Clinical outcomes of early gastric cancer patients after noncurative endoscopic submucosal dissection in a large consecutive patient series

“…This study demonstrated that OS and disease-free survival did not differ significantly between patients treated with additional surgical resection and patients undergoing simple follow-up after ESD. More recently, Yamanouchi et al [21] reported that the DSS rate did not differ significantly between observation and additional surgery groups after noncurative ESD, although there were only 79 noncurative gastric ESD patients in their report. In addition, Hoteya et al [22] described that gastric-cancer-related deaths and OS rates did not differ significantly between observation and additional surgery groups; however the number of noncurative gastric ESD patients included in this study was also less than 200 (165 patients).…”

“…Although several studies have described the clinical outcomes of noncurative gastric ER patients, the definition of noncurative gastric ER differs between studies; most of these studies have assessed the clinical outcomes of noncurative gastric ER patients in small numbers of patients without detailed statistical analysis [15][16][17][18][19][20][21][22][23][24][25]. For example, noncurative gastric ER was defined according to the Japanese gastric cancer treatment guidelines in some studies but was defined according to the original criteria in others [4,[15][16][17][18][19][20][21][22][23][24][25]. In addition, with the exception of two studies by Oda et al [15] and Yang et al [16], fewer than 200 noncurative gastric ER cases were included in previous studies [15][16][17][18][19][20][21][22][23][24][25].…”

“…For example, noncurative gastric ER was defined according to the Japanese gastric cancer treatment guidelines in some studies but was defined according to the original criteria in others [4,[15][16][17][18][19][20][21][22][23][24][25]. In addition, with the exception of two studies by Oda et al [15] and Yang et al [16], fewer than 200 noncurative gastric ER cases were included in previous studies [15][16][17][18][19][20][21][22][23][24][25]. To the best of our knowledge, the present study is the largest study demonstrating the clinical outcomes of more 500 noncurative gastric ESD patients, including long-term survival outcomes with a median follow-up period of more than 5 years and clinicopathological factors associated with metastasis and gastric-cancer-related death.…”

“…In general, noncurative ESD patients with a possible risk of LN metastasis are treated with additional gastrectomy; however, a relatively small number of these patients are selected to undergo simple follow-up without surgical treatment for various reasons [15]. Although several studies have reported clinical outcomes of noncurative gastric endoscopic resection (ER) patients, most of these reports have described clinical outcomes in a small number of patients without detailed assessments, with only two previous studies including more 200 noncurative gastric ER cases [15][16][17][18][19][20][21][22][23][24][25]. Therefore, we attempted to clarify the clinical outcomes of noncurative gastric ESD patients with a possible risk of LN metastasis by dividing the patients according to the following two treatment strategies on the basis of data from a large consecutive patient series: additional gastrectomy and simple follow-up.…”

Dysregulated lncRNA-UCA1 contributes to the progression of gastric cancer through regulation of the PI3K-Akt-mTOR signaling pathway

“…Despite improvements in gastrointestinal endoscopy and surgery, the prognoses of advanced gastric cancer patients remain poor, with a 5-year survival percentage of < 30% [20][21][22]. Studies of the molecular mechanisms involved in different stages of gastric cancer are urgently needed for the development of better methods of diagnoses and improvements in therapeutic treatments for this disorder.…”