Long-term outcomes after noncurative endoscopic resection of early gastric cancer: the optimal time for additional endoscopic treatment

Jeon, Mi Young; Park, Jun Chul; Hahn, Kyu Yeon; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

doi:10.1016/j.gie.2017.10.004

Cited by 47 publications

(52 citation statements)

References 25 publications

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“…Between the two groups with or without surgery, we concluded that there was no signi cant statistical difference from the K-M survival curve. Different from the previous studies [40,46], those patients under BEI group didn't bene t from the additional surgery neither the veyear overall survival nor the ve-year disease-speci c survival. Based on the eCura system, it could be a useful aid for selecting the appropriate treatment strategy after the noncurative ESD for EGCC [39].…”

Section: Discussioncontrasting

confidence: 84%

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Fan

Sun

Cao

et al. 2020

Preprint

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Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% ( P =0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively ( P <0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% ( P <0.001). The distant metastasis rate was 0.4%, 0% and 2.3% ( P =0.150). The five-year disease-specific survival rate in the BEI group was 96.6% ( P =0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

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Section: Discussioncontrasting

confidence: 84%

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Fan

Sun

Cao

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Many of these patients are elderly with significant comorbidity, and local disease control during their remaining years may be all that is required to prevent death or morbidity from gastric cancer. This is supported by a large South Korean retrospective study where such patients had a long-term cancer-specific survival of 86.2% 28 and a recent study demonstrating the feasibility of ESD in elderly patients. 29 In addition, the risk and morbidity of recurrent disease must be weighed against the considerable perioperative and quality of life risks of surgery in this cohort.…”

Section: Discussionmentioning

confidence: 66%

“…Most pEGCs were located in the gastric antrum (60/135, 44.4%) ( Table 2). The median size of pEGCs was 20 mm (interquartile range [IQR], [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], and this was larger in the expanded criteria (30 mm; IQR, 25-40) and outside criteria groups (30 mm; IQR, 20-50) versus the LGD LGD was commonly located in the antrum (24/42, 57.1%). The most common morphology of pEGC was Paris 0-IIa (54/135, 40.0%).…”

Section: Lesion Assessmentmentioning

confidence: 99%

Endoscopic submucosal dissection for suspected early gastric cancer: absolute versus expanded criteria in a large Western cohort (with video)

Tate

Klein

Sidhu

et al. 2019

Gastrointestinal Endoscopy

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Background and Aims: Endoscopic submucosal dissection (ESD) is an effective, minimally invasive, surgerysparing technique for the treatment of early gastric cancer (EGC). It is not well established whether EGC within the Japanese expanded criteria can be safely and effectively treated using ESD in the West. We describe the outcomes of ESD for endoscopically suspected, biopsy specimen-confirmed EGC and its adenomatous precursor lesions (pEGC) using the Vienna classification of dysplasia in a Western cohort. Methods: Prospective data were collected on all pEGCs undergoing ESD at a single expert endoscopy center. Outcomes were compared among pEGC, satisfying the Japanese absolute and expanded criteria, those outside criteria, and those specimens that contained low-grade dysplasia (LGD) only. Specialist GI pathologists reviewed and classified all ESD specimens. Patients were followed up at 6 and 12 months. Results: Over 71 months, 135 pEGCs in 121 patients (mean age, 72.0 years; 61.2% men) underwent ESD. Median pEGC size was 20 mm (interquartile range, 15-30), and 62 (45.9%) satisfied the expanded clinical criteria. Perforation occurred in 1.5% and postprocedural bleeding in 5.2%. Forty-two pEGCs (31.1%) contained LGD only. Rates of en bloc and R0 resection were 94.8% and 86.7%, respectively. One hundred seven pEGCs (79.2%) met the absolute or expanded criteria for endoscopic cure. Two pEGCs recurred during follow-up. Ten of 26 patients with pEGC (38.5%) outside criteria for cure underwent surgery after ESD with residual tumor detected in 3 specimens. Fifteen patients with outside criteria for pEGCs did not undergo surgery because of frailty or their expressed wish. Eleven of 15 patients have so far undergone first surveillance with 1 of 11 experiencing endoscopic and histologic recurrence. Conclusions: ESD is a safe and effective treatment for pEGCs in a Western context. Patients who either decline or are too frail for surgery, with outside criteria resections, may benefit from ESD for local disease control. Large Western studies of ESD for pEGCs are required to define long-term patient outcomes and surveillance guidelines, particularly where pathology shows LGD or high-grade dysplasia only.

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“…Retrospective cohort studies reported favorable prognoses following these endoscopic treatments and suggested that additional endoscopic treatments within 3 months after the initial endoscopic resection are associated with low recurrence rates. [172][173][174] However, it is impossible to determine whether resection is curative following argon plasma coagulation since histological evaluation is impossible; thus, a close follow-up is required after argon plasma coagulation.…”

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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Long-term outcomes after noncurative endoscopic resection of early gastric cancer: the optimal time for additional endoscopic treatment

Cited by 47 publications

References 25 publications

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Endoscopic submucosal dissection for suspected early gastric cancer: absolute versus expanded criteria in a large Western cohort (with video)

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

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