Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection

Kawata, Noboru; Kakushima, Naomi; Takizawa, Kohei; Tanaka, Masaki; Makuuchi, Rie; Tokunaga, Masanori; Takeda, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Sugino, Takashi; Kusafuka, Kimihide; Shimoda, Tadakazu; Nakajima, Takashi; Terashima, Masanori; Ono, Hiroyuki

doi:10.1007/s00464-016-5148-7

Cited by 79 publications

(91 citation statements)

References 28 publications

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“…This result indicates that additional gastrectomy with lymphadenectomy should be performed for lesions with lymphatic invasion. Some similar studies [20, 21] reported that lymphatic invasion was an independent risk factor for LNM in non-curative ER patients. Furthermore, all metastatic nodes were located in the perigastric area close to the primary tumors.…”

Section: Discussionmentioning

confidence: 97%

“…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. Kawata et al [20] and Suzuki et al [21] reported that there was a significant difference in OS between additional surgery and follow-up groups, although disease-specific survival did not differ significantly between the two groups. In patient clinical backgrounds, the follow-up group was significantly older than the additional surgery group, and several patients died of causes other than gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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BackgroundEndoscopic resection (ER) has been widely accepted as the standard treatment for early gastric cancer (EGC). However, in patients considered to have undergone non-curative ER due to their potential risk of lymph node metastasis (LNM), additional gastrectomy is recommended. The aim of the present study was to identify EGC patients after non-curative ER at high risk of LNM.MethodsA total of 150 patients who had undergone ER for EGC were diagnosed as non-curative ER due to their potential risk of LNM. Clinicopathological data and clinical outcomes were examined retrospectively.ResultsAdditional gastrectomy with lymph node dissection was performed in 73 patients, and the remaining 77 patients were followed-up without additional gastrectomy. In patients who underwent additional gastrectomy, 8 patients had local residual tumor, and 8 patients had LNM, which were limited in the peritumoral nodes. Only lymphatic invasion (p = 0.012) was a statistically significant factor for LNM. The 5-year overall survival and recurrence-free survival were not significantly different between patients with and without additional gastrectomy.ConclusionAdditional gastrectomy with lymph node dissection is recommended for patients who were diagnosed as non-curative ER with lymphatic invasion, and minimizing the extent of lymph node dissection may be allowed for these patients.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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%

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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“…In these patients, endoscopic resection (ER) is currently accepted as a curative treatment meeting the current treatment guidelines . After ER, the risk of lymph node metastasis (LNM) can be assessed based on several factors, including lymphovascular invasion, submucosal invasion, histological type, and size of the tumor, all well‐known risk factors for LNM . Non‐curative ER patients whose cases extend beyond the expanded criteria should receive additional surgery due to the risk of LNM.…”

Section: Introductionmentioning

confidence: 99%

“…Non‐curative ER patients whose cases extend beyond the expanded criteria should receive additional surgery due to the risk of LNM. In patients undergoing additional surgery for non‐curative ER, the LNM rate ranged from 5.7% to 10.4%, even in cases of intramucosal gastric cancer . In these non‐curative ER patients, additional curative surgery should be performed …”

Section: Introductionmentioning

confidence: 99%

The distribution pattern of metastatic lymph nodes after non‐curative endoscopic resection in early gastric cancer

Arroyo-Martinez

Han

Eom

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Additional surgery should be done after non‐curative endoscopic resection (ER) in early gastric cancer (EGC) due to the risk of lymph node metastasis (LNM). However, the distribution pattern of LNM in these patients is complicated and unpredictable. The aim of this study is to identify any different distribution patterns of LNM in patients with EGC who underwent additional surgery after non‐curative (ER) comparing to those without ER. Methods Patients who underwent surgery for EGC between 2001 and 2016 were included. Enrolled patients were divided into two groups, those who underwent additional surgery after non‐curative ER and those who underwent direct surgery without a history of ER. Demographics, tumor characteristics and LNM distribution pattern were analyzed. Results Among 4295 patients with EGC, 404 patients had a history of preoperative ER, and 3891 patients did not. After the application of exclusion criteria, 23 (7.1%) of 322 patients undergoing additional surgery had LNM. The additional surgery group showed less LNM, fewer nodal stations and more restricted distribution pattern of LNM. Conclusions The distribution pattern of LNM in EGC is complicated. However, more restricted locoregional LNM could be expected in cases of additional surgery after non‐curative ER than after direct surgery.

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Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection

Abstract: A detailed assessment of LVI is essential to the pathological evaluation of endoscopically resected specimens. An additional surgical resection should be strongly recommended for patients with LVI.

Cited by 79 publications

References 28 publications

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

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

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

The distribution pattern of metastatic lymph nodes after non‐curative endoscopic resection in early gastric cancer

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