Non-curative endoscopic resection does not always lead to grave outcomes in submucosal invasive early gastric cancer

Abstract

Non-curative resection in SM-GC does not always lead to cancer recurrence. Thus, if additional surgery cannot be performed because of the patient's unsuitable condition or refusal, a close follow-up with endoscopy can be considered as an alternative for carefully selected patients. Moreover, as the ESD technology continues to evolve, it might be possible to expand the criteria for curative ESD in patients with SM-GC.

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

“…Although several studies have described the clinical outcomes of noncurative gastric ER patients, the definition of noncurative gastric ER differs between studies; most of these studies have assessed the clinical outcomes of noncurative gastric ER patients in small numbers of patients without detailed statistical analysis [15][16][17][18][19][20][21][22][23][24][25]. For example, noncurative gastric ER was defined according to the Japanese gastric cancer treatment guidelines in some studies but was defined according to the original criteria in others [4,[15][16][17][18][19][20][21][22][23][24][25]. In addition, with the exception of two studies by Oda et al [15] and Yang et al [16], fewer than 200 noncurative gastric ER cases were included in previous studies [15][16][17][18][19][20][21][22][23][24][25].…”

“…For example, noncurative gastric ER was defined according to the Japanese gastric cancer treatment guidelines in some studies but was defined according to the original criteria in others [4,[15][16][17][18][19][20][21][22][23][24][25]. In addition, with the exception of two studies by Oda et al [15] and Yang et al [16], fewer than 200 noncurative gastric ER cases were included in previous studies [15][16][17][18][19][20][21][22][23][24][25]. To the best of our knowledge, the present study is the largest study demonstrating the clinical outcomes of more 500 noncurative gastric ESD patients, including long-term survival outcomes with a median follow-up period of more than 5 years and clinicopathological factors associated with metastasis and gastric-cancer-related death.…”

“…Although their study thoroughly evaluated the long-term survival outcomes, it included noncurative gastric endoscopic mucosal resection patients in addition to noncurative gastric ESD patients with a median follow-up period of less than 5 years. Choi et al [20] reported the long-term survival outcomes of noncurative gastric ESD patients with submuscosa-invasive gastric cancer (n = 89). This study demonstrated that OS and disease-free survival did not differ significantly between patients treated with additional surgical resection and patients undergoing simple follow-up after ESD.…”

“…In general, noncurative ESD patients with a possible risk of LN metastasis are treated with additional gastrectomy; however, a relatively small number of these patients are selected to undergo simple follow-up without surgical treatment for various reasons [15]. Although several studies have reported clinical outcomes of noncurative gastric endoscopic resection (ER) patients, most of these reports have described clinical outcomes in a small number of patients without detailed assessments, with only two previous studies including more 200 noncurative gastric ER cases [15][16][17][18][19][20][21][22][23][24][25]. Therefore, we attempted to clarify the clinical outcomes of noncurative gastric ESD patients with a possible risk of LN metastasis by dividing the patients according to the following two treatment strategies on the basis of data from a large consecutive patient series: additional gastrectomy and simple follow-up.…”

Management of early gastric cancer that meet the indication for radical lymph node dissection following endoscopic resection: a retrospective cohort analysis

“…Choi et al [22] also reported that OS and disease-free survival did not differ significantly between patients treated with additional surgical resection and patients simply followed up after ESD in submucosa-invasive gastric cancer. However, this result should be carefully interpreted, because histological analysis demonstrated that the patients who underwent gastrectomy showed significantly higher lymphatic-vascular involvement and deeper submucosal invasion than those followed up without gastrectomy (Table 1), indicating that the patients with these unfavorable histological findings were more frequently selected for additional gastrectomy.…”