Long-term outcomes of patients with early gastric cancer found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after endoscopic submucosal dissection

Yano, Takafumi; Ishido, Kenji; Tanabe, Satoshi; Wada, Takuya; Azuma, Mizutomo; Kawanishi, Natsuko; Yamane, Sakiko; Watanabe, Akinori; Katada, Chikatoshi; Koizumi, Wasaburo

doi:10.1007/s00464-017-5809-1

Cited by 15 publications

(24 citation statements)

References 21 publications

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“…Based on the previous reports, 53,54,[57][58][59][60][61][63][64][65][66][67][68][69][70] LNM was not shown in 89.0% to 94.8% of patients who underwent additional surgery after noncurative ER for EGC. Accordingly, additional surgery for all such patients may be excessive and further risk stratification can be useful for deciding treatment strategy after ER.…”

Section: Risk-scoring System For Patients With Noncurative Resectionmentioning

confidence: 90%

“…[55][56][57][58][59][60][61] All studies showed that the OS in patients with no additional treatment (72.0% to 85.0%) was lower than that in patients with additional surgery (85.0% to 96.0%). 55,[57][58][59][60][61] However, this difference may be largely affected by a selection bias in the treatment strategy after ER because there is a discrepancy in the OS and disease-specific survival (DSS) between no additional treatment and additional surgery groups. In fact, the 5-year DSSs in patients with additional treatment and those with no additional treatment were 98.7% to 100% and 92.6% to 97.5%, respectively.…”

Section: Noncurative Resectionmentioning

confidence: 99%

“…The rate of LNM in patients who underwent additional surgery after noncurative resection of ER for EGC is reported to be 5.2% to 11.0%. 53,54,[57][58][59][60][61][63][64][65][66][67][68][69][70] Most reports are from Korea and Japan, and only one study has been reported from Western countries. 53 In this study, LNM after noncurative resection was shown in 8.3% of the patients (1/12), 53 which is similar to the rate of LNM (8.5%) in the largest study from Japan.…”

Section: Lnm In Patients With Additional Surgery After Noncurative Rementioning

confidence: 99%

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A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

et al. 2020

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Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established. (Gut Liver 2020;14:412-422 ) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Risk-scoring System For Patients With Noncurative Resectionmentioning

confidence: 90%

Section: Noncurative Resectionmentioning

confidence: 99%

Section: Lnm In Patients With Additional Surgery After Noncurative Rementioning

confidence: 99%

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A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

et al. 2020

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“…In this category, until JGCA guidelines version 4, additional surgery was recommended for all patients as a result of the potential risk of LNM. However, the rate of LNM in such patients was only 5.2%–11.0% . Thus, this recommendation may have been excessive.…”

Section: Management After Er In Each Curability Categorymentioning

confidence: 98%

“…However, the rate of LNM in such patients was only 5.2%-11.0%. 38,[47][48][49][50][51][52][53][54][55][56][57][58][59][60] Thus, this recommendation may have been excessive. In the JGCA guidelines version 5, 13 the statement for the management of eCura C-2 was changed as follows: "Additional surgery is the standard treatment method, but clinicians should decide considering the patient's physical condition."…”

Section: Ecura C-2mentioning

confidence: 99%

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

Hatta

Gotoda

Koike

et al. 2019

Digestive Endoscopy

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Japanese guidelines for gastric cancer treatment were first published in 2001 for the purpose of showing the appropriate indication for each treatment method, thereby reducing differences in the therapeutic approach among institutions, and so on. With the accumulation of evidence and the development and prevalence of endoscopic submucosal dissection (ESD), the criteria for the indication and curability of endoscopic resection (ER) for early gastric cancer (EGC) have expanded. However, several problems still remain. Although a risk-scoring system (eCura system) for predicting lymph node metastasis (LNM) may help treatment decision in patients who do not meet the curative criteria for ER of EGC, which is referred to as eCura C-2 in the latest guidelines, additional gastrectomy with lymphadenectomy may be excessive for many patients, even those at high risk for LNM. Less-invasive function-preserving surgery, such as non-exposed endoscopic wall-inversion surgery with laparoscopic sentinel node sampling, may overcome this problem. In addition, further less-invasive treatment, such as ER with chemotherapy, should be established for patients who prefer not to undergo additional gastrectomy. CONCEPT AND UPDATE OF THE JAPANESE GUIDELINESJ APANESE GASTRIC CANCER Association (JGCA) guidelines were first published in 2001 9 for the purpose of: (i) showing the appropriate indication of each treatment method for gastric cancer; (ii) reducing differences in the therapeutic approach among institutions; (iii) improving the safety and outcome of treatment for gastric cancer; (iv) reducing the personnel and economic burden by avoiding unnecessary treatment; and (v) improving mutual understanding between medical staff and patients. With the accumulation of evidence, the guidelines were updated in

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Endoscopic Submucosal Dissection of Gastric Lesions

Gotoda

2021

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Long-term outcomes of patients with early gastric cancer found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after endoscopic submucosal dissection

Cited by 15 publications

References 21 publications

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

Endoscopic Submucosal Dissection of Gastric Lesions

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