Gastric cancer treated by endoscopic submucosal dissection or endoscopic mucosal resection in Japan from 2004 through 2006: JGCA nationwide registry conducted in 2013

Tanabe, Satoshi; Hirabayashi, Shigeki; Oda, Ichiro; Ono, Hiroyuki; Nashimoto, Atsushi; Isobe, Yoh; Miyashiro, Isao; Tsujitani, Shunichi; Seto, Yasuyuki; Fukagawa, Takeo; Nunobe, Souya; Furukawa, Hiroshi; Kodera, Yasuhiro; Kaminishi, Michio; Katai, Hitoshi

doi:10.1007/s10120-017-0699-4

Cited by 56 publications

(42 citation statements)

References 24 publications

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“…The outcomes were similar to the results presented in the literature, with an en bloc R0 resection rate reaching 90% and a cure rate of > 80%, with a good safety profile [14, 15]. All adverse events (10.5% rate of bleeding and 0.9% rate of perforation) were controlled endoscopically and none of the patients needed surgery.…”

Section: Discussionsupporting

confidence: 71%

“…This study confirmed the low risk of lymph node metastasis in expanded criteria patients and ESD as the best staging tool before surgery for EGC [3, 9, 15]. However, when lesions were divided into two groups of indications (absolute versus expanded indications), the second group presented lower rates of R0 (96.6 vs. 79.1%, p = 0.007) and curative resection (96.8 vs. 79.1%, p = 0.007), with an increased residual lesion rate (0 vs. 13.3%, p = 0.024), confirming a recent meta-analysis [24], although endoscopically treatable in most of the cases.…”

Section: Discussionmentioning

confidence: 52%

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Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Costa

Ferreira

Leal

et al. 2018

GE Port J Gastroenterol

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Background: The emergence of endoscopic submucosal dissection (ESD) made possible en bloc resection of neoplastic gastric lesions, regardless of lesion size, with reduced rates of complications and recurrence. This technique has become the preferred method for curative resection, instead of conventional endoscopic mucosal resection and surgery, when distant metastases have negligible risk. In Western countries experience with this technique has evolved quickly, with an increasing number of case series reported in the literature. This study aims to report the short- and long-term outcomes of ESD in gastric epithelial neoplastic lesions by a single operator in a Portuguese centre. Methods: A retrospective analysis of all gastric ESDs in a tertiary specialised unit during a 5-year period, between May 2012 and September 2017, was performed. Results: A total of 114 ESDs of gastric epithelial lesions were performed during this period; 96.5% of them were removed en bloc and 87.6% with R0 resection. A curative treatment was achieved in 83.2% of the cases. Complications occurred in 13.2% of the procedures, including early and delayed bleeding in 12 patients (10.5%) and one perforation (0.9%). With a median follow-up period of 12 months (interquartile range [IQR] = 18), 6 cases of recurrence at the previous ESD site were diagnosed: 4 residual lesions and 2 local recurrences in previous R0 resections. Residual lesions occurred more often in patients with larger lesions (median = 40.0 mm, IQR = 26 vs. median = 20.0 mm, IQR = 15, p = 0.008) and with positive horizontal margins (HMs) after resection (50.0 vs. 0.0%, Fisher exact test, p < 0.001). The cumulative incidence of metachronous gastric lesions at 34 months was 16.1%. All new lesions were effectively treated using an endoscopic technique. The disease-specific survival at 12 months was 100%. Conclusion: This study showed that ESD is an effective resection technique for gastric lesions with a good safety profile, confirming other European series. Regardless, high en bloc resection positive HM is still a problem in some specimens resected by ESD. Endoscopic surveillance can detect local recurrence and new lesions during early stages, potentially treatable by endoscopy.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 52%

Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Costa

Ferreira

Leal

et al. 2018

GE Port J Gastroenterol

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“…The indications of EGC for endoscopic resection may be reasonably expanded. However, the first and second expanded indications have recently been included as the updated absolute indications in Japan based on the evidence that EGC with prior expanded indications have a similar prognosis to those with prior absolute indications …”

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 99%

“…Endoscopic resection, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), has been regarded as standard treatment for early gastric cancers (EGC) . With the advances in endoscopic techniques, a 5‐year overall survival rate of more than 90% has been achieved in patients with EGC fulfilling the absolute or expanded endoscopic indications . Not only has the endoscopic treatment of EGC been widely applied in Asian countries but this technology has been gradually accepted and attracted the attention of endoscopists from Western countries …”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Zhang

Gao

et al. 2019

J of Digest Diseases

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With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow-up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level-C1 EGC. For patients with a level-C2 EGC, close follow-up is suggested for low-risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes. K E Y W O R D Scurative resection, early gastric cancer, eCura system, endoscopy, gastric neoplasms, surveillance

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“…Die endoskopische Submukosa-Dissektion (ESD) ist eine insbesondere in Asien akzeptierte endoskopische Technik zur Behandlung von Magenfrühkarzinomen (MFK) [1,2]. Auch in Europa wird diese Methode immer häufiger angewendet [3,4].…”

Section: Introductionunclassified

Endoskopische Submukosa-Dissektion bei mukosalen Low-Risk-Magenfrühkarzinomen – eine retrospektive, unizentrische Studie

2018

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Zusammenfassung Hintergrund Die endoskopische Submukosa-Dissektion (ESD) ist in Asien Standard zur Behandlung von Magenfrühkarzinomen (MFK) im Rahmen von definierten Kriterien. Auch in Europa wird sie immer häufiger benutzt. Bei Risikokonstellationen (z. B. Submukosa-Invasion, Lymphangio-Invasion, schlecht differenziertes Karzinom) ist das Auftreten von Lymphknotenmetastasen möglich. Wir definierten eine „Low-Risk-Gruppe“ (differenzierte, nur mukosal gelegene MFK ohne Ulzeration und Gefäßinfiltration, größenunabhängig) um das endoskopische Ergebnis und den Langzeitverlauf dieser prognostisch günstigen Gruppe zu untersuchen. Patienten und Methoden Patienten mit nicht vorbehandelten Low-Risk-MFK wurden in die retrospektive Auswertung aufgenommen. Ausgewertet wurden Patientendaten (Alter, Geschlechterverteilung), Karzinomparameter (Anzahl, Größen, Lokalisation, Paris-Klassifikation), histologische Parameter, Resektionsdaten (u. a. En-bloc-Resektion, R-Status), Nachsorgen (u. a. Lokalrezidive, Überleben) und Komplikationsdaten. Ergebnisse Durch ESD wurden bei 55 Patienten 61 Low-Risk-MFK entfernt. In 93,4 % gelang die En-bloc-, in 91,8 % die R0-Resektion. In 8 Fällen (13,1 %) kam es zu interventionsabhängigen Komplikationen: 5 verzögerte Nachblutungen (8,2 %), 2 Mikroperforationen (3,3 %, keine Operation notwendig) und ein Nicht-ST-Hebungsinfarkt (1,6 %).Während der Nachbeobachtungszeit (Mittelwert: 54,3 Monate) kam es in 4 Fällen (6,6 %) zu Lokalrezidiven, von welchen zumindest zwei erfolgreich endoskopisch behandelt werden konnten. Die anderen beiden Patienten verstarben nach endoskopischer Re-Therapie vor der ersten Kontrolle. Insgesamt verstarben 4 Patienten (7,8 %) während des Follow-ups, jeweils nicht tumorassoziiert. Bei 9 Patienten (16,4 %) wurden syn- oder metachrone Läsionen nachgewiesen, welche alle endoskopisch behandelt werden konnten. Lymphknotenmetastasen traten nicht auf. Fazit In der von uns definierten Low-Risk-Gruppe von mukosalen MFK wurde mittels ESD eine hohe Rate von En-bloc- und R0-Resektionen erreicht. Die festgestellten Lokalrezidive konnten endoskopisch beherrscht werden. Metastasen wurden nicht festgestellt, kein Patient verstarb tumorassoziiert. ESD ist für diese Gruppe daher als Standard-Therapie zu empfehlen. Hinsichtlich des klinisch-endoskopischen Verlaufs bei Vorhandensein von Risikofaktoren sowohl bei Mukosakarzinomen als auch der übrigen MFK aus der sogenannten Expanded-Group (u. a. Lymphangio-Invasion, submukosainvasive MFK, schlecht differenzierte G3-Karzinome) liefert die Studie keine Daten.

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Gastric cancer treated by endoscopic submucosal dissection or endoscopic mucosal resection in Japan from 2004 through 2006: JGCA nationwide registry conducted in 2013

Abstract: Endoscopic resection of gastric cancer resulted in favorable short-term and long-term outcomes nationwide in Japan. Further efforts to increase the follow-up rate are needed.

Cited by 56 publications

References 24 publications

Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Endoskopische Submukosa-Dissektion bei mukosalen Low-Risk-Magenfrühkarzinomen – eine retrospektive, unizentrische Studie

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