Long‐term outcomes of endoscopic submucosal dissection for early gastric cancer: <scp>A</scp> single‐center retrospective study

Kubo, Takashi; Endo, Masaki; Toya, Yosuke; Abiko, Yukito; Kudara, Norihiko; Inomata, Masaaki; Chiba, Tetsuhiro; Takikawa, Yasuhiro; Suzuki, Kazuyuki; Sugai, Tamotsu

doi:10.1111/den.12099

Cited by 115 publications

(101 citation statements)

References 25 publications

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“…However, there are few published reports on the long-term outcomes with median follow-up periods of over 5 years ( [10,11,13] reported favorable long-term outcomes of gastric ESD with median follow-up periods of over 5 years; however, the number of cases included in those studies was fewer than the number included in our study. Oda et al [12] also reported the favorable long-term outcomes of curative gastric ESD over follow-up periods of at least 5 years; however, they reported preliminary results of a multicenter questionnaire survey without collecting individual patient data, meaning that they could not estimate the long-term outcomes using the Kaplan-Meier method.…”

Section: Discussionmentioning

confidence: 58%

“…Recently, ESD has been performed to treat EGCs, including large and ulcerative lesions, and there have been a number of published reports on the short-and long-term outcomes of ESD for EGC [1][2][3][4][5][6][7][8][9][10][11][12][13]. However, there are few published reports on the long-term outcomes with median follow-up periods of over 5 years ( [10,11,13] reported favorable long-term outcomes of gastric ESD with median follow-up periods of over 5 years; however, the number of cases included in those studies was fewer than the number included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the number of EGC patients undergoing ESD has been increasing in Japan. Although a number of reports have indicated favorable short-and longterm outcomes of ESD for EGC, there are few published data on the long-term outcomes of gastric ESD with a median follow-up period of over 5 years [5][6][7][8][9][10][11][12][13]. Therefore, we attempted to assess the long-term outcomes of ESD for EGC based on the data from our large consecutive patient series.…”

Section: Introductionmentioning

confidence: 99%

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High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

et al. 2015

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Background Endoscopic submucosal dissection (ESD) has been used to treat patients with early gastric cancers (EGCs), including large and ulcerative lesions. Few published data exist on the long-term outcomes of this treatment with median follow-up periods of over 5 years; we therefore aimed to assess the long-term outcomes of EGC patients undergoing ESD. Methods A total of 1,956 consecutive patients with 2,210 EGC lesions at initial onset underwent ESD with curative intent at our hospital from 1999 to 2006. We performed a retrospective analysis of the 5-year survival of EGC patients undergoing curative ESD for absolute indications or for expanded indications. Results For the pathological curability, curative ESD for absolute indications, curative ESD for expanded indications of differentiated-type EGC, and curative ESD for undifferentiated-type EGC were achieved in 781, 713, and 43 patients, respectively. The median follow-up period was 83.3 months. Among the 1,537 patients, there were only two patients with recurrence, including one who developed a regional lymph node (LN) metastasis and one who developed a distant LN metastasis with local recurrence resulting in gastric cancer-related death. Seven died from metachronous gastric cancers. The 5-year rates of overall survival, disease-specific survival, and relative survival were 92.6, 99.9, and 105.0 %, respectively.Conclusions Based on the high rate of 5-year survival among EGC patients undergoing curative ESD for absolute indications or for expanded indications in the largest patient series with a median follow-up period of over 5 years, ESD could be employed as a standard treatment for EGC lesions.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

et al. 2015

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“…Expanded indication lesions were associated with higher PPB in 1 study, 63 whereas PPB was not significantly different between standard and expanded indications in 3 studies despite a tendency for higher bleeding in the latter group. 48,64,65 Ulceration was not associated with PPB, 14 27 Submucosal fibrosis has also been analyzed and was not identified as an independent risk factor. 13,14,61,67 The presence of scarring was not identified as an influence on PPB in 3 studies, 32,51,58 although it was associated with higher PPB in 2 studies.…”

Section: Risk Factors For Post-esd Bleeding Risk Factormentioning

confidence: 99%

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

Libânio

Costa

Pimentel‐Nunes

et al. 2016

Gastrointestinal Endoscopy

110

127

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“…Endoscopic submucosal dissection (ESD) is currently performed for early gastric cancer (EGC) with negligible risk of lymph node (LN) metastasis; the reported curative resection rates range from 73.6 to 94.7 % [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. However, cases of noncurative resection still exist because the precise endoscopic prediction of EGC in terms of tumor depth, lateral spread, or lymphovascular invasion is difficult before treatment [5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Background Clinical outcomes of early gastric cancer (EGC) patients after noncurative endoscopic submucosal dissection (ESD) have not been fully elucidated; we therefore aimed to clarify these outcomes. Methods A total of 3058 consecutive patients with 3474 clinically diagnosed EGCs at initial onset underwent ESD with curative intent at our hospital between 1999 and 2010. We retrospectively assessed the following clinical outcomes of noncurative gastric ESD patients with a possible risk of lymph node (LN) metastasis by dividing patients into two groups with different treatment strategies (additional gastrectomy and simple follow-up): presence of LN metastasis at the time of gastrectomy, incidence of LN and distant metastases during the follow-up period, clinicopathological factors associated with metastasis, and 5-year disease-specific survival (DSS). Results After exclusion of 75 noncurative ESD patients with only a positive horizontal margin, 569 noncurative ESD patients with a possible risk of LN metastasis were identified. Among the 356 patients undergoing additional gastrectomy, LN metastasis was identified in 18 patients. A positive vertical margin with submucosal invasion (odds ratio 3.6) and lymphovascular invasion (odds ratio 3.5) were significantly associated with LN metastasis. The 5-year DSS rate was 98.8 %. Among the 212 patients who underwent simple follow-up, LN and/or distant metastases were found in eight patients. In this group, lymphovascular invasion (hazard ratio 6.6) was significantly associated with metastasis with a 5-year DSS rate of 96.8 %.Conclusions Additional gastrectomy should be performed particularly in noncurative gastric ESD patients with lymphovascular invasion or a positive vertical margin with submucosal invasion.

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Long‐term outcomes of endoscopic submucosal dissection for early gastric cancer: A single‐center retrospective study

Abstract: ESD can be considered a standard treatment for EGC based on its expanded indications and low incidences of local recurrence and lymph node metastasis.

Cited by 115 publications

References 25 publications

High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

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

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