Impact of non-curative endoscopic submucosal dissection on short- and long-term outcome of subsequent laparoscopic gastrectomy for pT1 gastric cancer

Shimada, Shoji; Sawada, Naruhiko; Oae, Sonoko; Seki, Junichi; Takano, Yojiro; Nakahara, Kazunari; Takehara, Yusuke; Mukai, Shoichiro; Ishida, Fumio; Kudo, Shin‐ei

doi:10.1007/s00464-021-08718-1

Cited by 4 publications

(2 citation statements)

References 40 publications

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“…Aligning with latest guidelines, multivariate regression analysis identified age ≥60 years (P=0.01), depressed gross type (P=0.006), and eCuraC-2 (P=0.04) as independent risk factors for NCR necessitating further surgery. In addition to these factors evaluated in this study, a recent study by Japanese scholars pointed out that additional gastrectomy after non-curative ESD for pT1 EGC could provide an oncologically safe outcome ( 24 ). With the continuous development of endoscopic technology, an increasing number of expanded ESD are being performed.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of non-curative endoscopic submucosal dissection for early gastric cancer

Ma,

Xu,

et al. 2024

J Gastrointest Oncol

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Background Early gastric cancer (EGC) is defined as cancer cells confined to the mucosal or submucosal layer, irrespective of size or presence of lymph node metastasis. The recent EGC endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) guidelines (2021 Japan Gastroenterological Endoscopy Society (JGES) guidelines, 2nd edition) revised the concept from “endoscopic curative/non-curative resection” (NCR) to “endoscopic curability (eCura)”. Under this, eCuraA and eCuraB signify curative resections (CRs), while eCuraC (including eCuraC-1 and eCura-C2) indicate NCRs. This study retrospectively analyzes clinical and pathological data from EGC patients who underwent endoscopic resection, assessing the long-term clinical outcomes in a substantial cohort after undergoing NCR. Methods We retrospectively analyzed clinical and pathological data from 443 EGC patients, encompassing 478 lesions, who received endoscopic treatment. The long-term clinical outcomes of patients who underwent NCR were statistically evaluated. Characteristics of the NCR group were compared with those of the surgical group, employing single- and multi-factor logistic regression analyses to identify risk factors that necessitate further surgical intervention. Prognostically, the Kaplan-Meier method and Log-Rank test determined the impact of risk factors on recurrence-free survival post-surgery in NCR patients. Differences were assessed using a method incorporating statistically significant differences in the multi-factor Cox regression analysis, evaluating the hazard ratio (HR) for disease recurrence following NCR. Results In this study, 443 EGC cases were pathologically diagnosed, comprising a total of 478 lesions. Of these, 127 cases underwent non-curative endoscopic resection, resulting in a NCR rate of 24.4%. Long-term follow-up was achieved for 117 (92.12%) patients. The metastasis/recurrence rate at 6 months stood at 23.1%. Multivariate Cox regression analysis identified lesion size ≥2.0 and <3 cm [P=0.02, HR =0.12, 95% confidence interval (CI): 0.02–0.67], presence of ulceration (P=0.03, HR =5.48, 95% CI: 1.23–24.33), lymphatic invasion (P=0.05, HR =17.51, 95% CI: 1.07–286.23), positive vertical margins (P=0.09, HR =3.77, 95% CI: 0.81–17.53), and flat macroscopic morphology (P=0.048, HR =4.8, 95% CI: 1.01–22.73) as independent risk factors for recurrence-free survival post non-curative endoscopic resection in EGC patients. Conclusions The recurrence/metastasis rate in patients who underwent NCR is notably higher compared to the control group. Significant prognostic risk factors include tumor size ≥2.0 and <3 cm, positive vertical margins, lymphatic invasion, and flat type (one of pathological gross classification). Patients in the eCuraC-2 category of NCR should consider further surgical intervention. The necessity for additional surgical intervention in these patients warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome of non-curative endoscopic submucosal dissection for early gastric cancer

Ma,

Xu,

et al. 2024

J Gastrointest Oncol

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“…Lastly, ESD provides comparable survival outcomes to surgery. Although ESD may have a higher incidence of metachronous lesions, successful treatment is available in most cases with repeated ESD, and a history of ESD does not negatively affect subsequent surgical treatment [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison between Endoscopic Submucosal Dissection and Surgery in Patients with Early Gastric Cancer

Qian

Sheng

et al. 2022

Cancers

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Background: Endoscopic submucosal dissection (ESD) has become a preferred treatment option for early gastric cancer (EGC). This study aimed to compare the clinical outcomes of ESD and surgical resection for EGC. Methods: This was a retrospective case–control study. Patients with a diagnosis of EGC who underwent ESD or surgery in our hospital from 2011 to 2020 were enrolled. We compared the clinical characteristics and treatment outcomes of these two groups according to propensity score-matching. The primary outcome comparison was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related events. Results: In the matched cohort, the ESD group showed comparable OS, RFS, and DSS with the surgery group. Statistical differences were shown in blood loss and adverse events. Furthermore, the ESD group showed lower hospital cost, as well as a shorter operative time and hospital duration than the surgery group. The R0 resection and recurrence rates were similar between the two groups. In Cox regression analysis, age, tumor size, poor differentiation, and lymphovascular invasion were regarded as independent factors of OS. Conclusions: With sufficient safety and advantages, ESD can be a first-line treatment of EGC. Preoperative evaluation is vital to the appropriate treatment and prognosis.

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Short-term efficacy of additional laparoscopic-assisted radical gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer

Hu,

Wang,

et al. 2023

Langenbecks Arch Surg

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Impact of non-curative endoscopic submucosal dissection on short- and long-term outcome of subsequent laparoscopic gastrectomy for pT1 gastric cancer

Cited by 4 publications

References 40 publications

Clinical outcome of non-curative endoscopic submucosal dissection for early gastric cancer

Clinical outcome of non-curative endoscopic submucosal dissection for early gastric cancer

Comparison between Endoscopic Submucosal Dissection and Surgery in Patients with Early Gastric Cancer

Short-term efficacy of additional laparoscopic-assisted radical gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer

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