Propensity score-matched comparison of short-term and long-term outcomes between endoscopic submucosal dissection and surgery for treatment of early gastric cancer in a Western setting

Baušys, Rimantas; Baušys, Augustinas; Stanaitis, Juozas; Vysniauskaite, Indre; Maneikis, Kazimieras; Bausys, Bernardas; Stratilatovas, Eugenijus; Strupas, Kęstutis

doi:10.1007/s00464-018-06609-6

Cited by 21 publications

(16 citation statements)

References 30 publications

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“…Globally, the procedures for endoscopic resection, such as polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD), are widely performed 1–3 . Endoscopic resection is gaining increasing attention and acceptance in Japan and Western countries 4–9 . However, the benefits and risks often coexist.…”

Section: Introductionmentioning

confidence: 99%

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Zhu

Tao

et al. 2021

J of Gastro and Hepatol

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Background and Aim Oral anticoagulants are risk factors for post‐endoscopic resection bleeding. We aimed to conduct a systematic review and meta‐analysis for the risks of post‐procedural bleeding (PPB) for direct oral anticoagulants (DOACs) and warfarin following endoscopic resection. Methods Two independent reviewers searched PubMed, Web of Science, Embase, and Cochrane Library. The Newcastle–Ottawa Scale score was used to assess the quality of the studies, the pooled odds ratio (OR) to present PPB results, and the funnel plots to assess publication bias. The Higgins I2 statistic was employed to determine the variation across studies due to heterogeneity. Results We reviewed 30 articles. PPB occurred in 586 patients on DOACs and 1782 on warfarin. The patients on DOACs had a significantly lower overall risk of PPB compared with those on warfarin (OR, 0.867, 95% confidence interval, 0.771–0.975; P = 0.017, I2 = 1.6%). Cumulative meta‐analysis showed that the PPB rate of DOACs has the trend to be lower than that of warfarin with publication year and sample size. For the subgroup of endoscopic submucosal dissection, the PPB of DOACs was significantly lower than that of warfarin (OR, 0.786; 95% confidence interval, 0.633–0.976; P = 0.029, I2 = 0%). No significant difference was observed between DOACs and warfarin for anticoagulant strategies, endoscopic procedures, and lesion location. Conclusions Compared with warfarin, DOACs have the possibility to significantly decrease the risk of PPB following endoscopic resection, especially for endoscopic submucosal dissection.

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Section: Introductionmentioning

confidence: 99%

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Zhu

Tao

et al. 2021

J of Gastro and Hepatol

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“…Additionally, minimally invasive procedures such as endoscopic submucosal dissection (ESD), and endoscopic mucosal dissection (EMD) are becoming increasingly frequent in early gastric cancer without lymph node metastasis, [85] as they are physiologically less stressful, resulting in a shorter postoperative hospital stay and has a lower postoperative morbidity rate. There was no difference in survival between the 2 methods in a study comparing curative ESD/EMD and gastrectomy [85] . The major risk of ESD is that pathological N status is not determined, because lymph node resection is not performed [86] .…”

Section: Discussionmentioning

confidence: 99%

Association between neutrophil-lymphocyte ratio and lymph node metastasis in gastric cancer

et al. 2022

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Introduction and Aim: The prognostic role of neutrophil to lymphocyte ratio (NLR) has been explored extensively in the literature. The aim of this meta-analysis was to evaluate the link between NLR and lymph node metastasis in gastric cancer. A method for increasing specificity and sensitivity of pre-treatment staging has implications on treatment algorithms and survival. Search Strategy: The relevant databases were searched as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. After selection, 12 full text articles that met the inclusion criteria were included for quantitative analysis. 2 × 2 squares were generated using lymph node positive/negative, and NLR high/low data. The effect size for each study was calculated using the DerSimonian–Laird random effects model. P values were calculated using the chi-square method. Finally publication bias was evaluated. All statistics were calculated using R Studio. Results: Meta-analysis showed a 1.90 times (odds ratio, with 95% CI 1.52–2.38) increase in risk of positive lymph node status with high neutrophil to lymphocyte ratio. This has significant implications for cancer screening and staging, as NLR is a highly reproducible, cost-effective, and widely available prognostic factor for gastric cancer patients. Additionally, high or low NLR values may have implications for management pathways. Patients with lymph node metastasis can be offered neoadjuvant chemotherapy, avoiding salvage therapy in the form of adjuvant chemoradiotherapy, which is poorly tolerated. Conclusion: This meta-analysis shows an association between NLR and positive lymph node status in gastric cancer patients with implications for staging, as well as preoperative personalisation of therapy.

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“…In comparison, multicenter studies of ESD for EGC at Eastern institutions have reported similar en bloc resection rates of 92.7-96.1% and R0 resection rates of 82.6-94.5% with bleeding rates of 0.6-9.9% and perforation rates of 3.6-4.7% [31]. In a retrospective case-control study including 260 western EGC patients, ESD could significantly reduce the operation time and postoperative hospitalization stay, and prolong 5-year disease-free survival (DFS) (All P < 0.05) [32]. However, a retrospective analysis based on the National Cancer Database indicated that endoscopic resection was inferior in terms of prognosis for cT1aN0 and cT1bN0 GC when compared with gastrectomy and suggested that a construction of a subset considering the risk of LN metastasis was beneficial to prolong EGC patients' survival from endoscopic resection [33].…”

Section: Discussionmentioning

confidence: 99%

Prediction Model of Lymph Node Metastasis Risk in Elderly Patients with Early Gastric Cancer before Endoscopic Resection: A Retrospective Analysis Based on International Multicenter Data

Pan

Tan

et al. 2021

J. Cancer

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Background: Patients with early gastric cancer (EGC) must suffer reoperation if diagnosed with a high possibility of lymph node (LN) metastasis. The purpose of the current study was to develop and validate a model to predict the risk of LN metastasis in elderly patients before endoscopic resection. Methods: A total of 1911 EGC patients who had undergone radical surgery were selected and assigned randomly (2:1) to either the training cohort or the validation cohort. A nomogram was established based on the univariate and multivariate logistic regression models using the training cohort. Cox proportional hazards regression models were applied to identify the prognostic factors in univariate and multivariable analyses. Results: Three variables—tumor size, grade, and T stage—were derived from the multivariate analyses in the training cohort and incorporated into the nomogram. The AUC of the nomogram was 0.732 in the training cohort and 0.706 in the validation cohort. There were significant differences in survival among patients with different degrees of LN metastasis risk (training cohort: five-year disease-specific survival (DSS): low risk 88.1% vs. moderate risk 80.0% vs. high risk 72.9%, P < 0.001; validation cohort five-year DSS: low risk 89.0% vs. moderate risk 84.3% vs. high risk 72.2%, P < 0.001). The LN metastasis risk assessed from the model was also an independent prognostic factor. Conclusion: We established a nomogram that accurately predicts LN metastasis risk for elderly patients with EGC before endoscopic resection to avoid further injury from reoperation.

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Propensity score-matched comparison of short-term and long-term outcomes between endoscopic submucosal dissection and surgery for treatment of early gastric cancer in a Western setting

Cited by 21 publications

References 30 publications

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Association between neutrophil-lymphocyte ratio and lymph node metastasis in gastric cancer

Prediction Model of Lymph Node Metastasis Risk in Elderly Patients with Early Gastric Cancer before Endoscopic Resection: A Retrospective Analysis Based on International Multicenter Data

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