Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer

Min, Byung‐Hoon; Kim, Eun Ran; Kim, Kyoung‐Mee; Park, Cheol Keun; Lee, Jun Haeng; Rhee, Poong–Lyul; Kim, Jae J.

doi:10.1055/s-0034-1392249

Cited by 90 publications

(67 citation statements)

References 25 publications

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“…reported that the risk of lymph node metastasis was zero in patients with EGC that met the expanded indication [11]. The reported 5-year overall survival rate of ESD for EGC, which met expanded indication, was over 95% [3,4]. However, if the pathologic result of ESD is non-curative, surgical gastrectomy should be recommended because the patient’s risk of either recurrence or lymph node metastasis might be higher than in curative resected patients.…”

Section: Discussionmentioning

confidence: 99%

“…After introduction of ESD, the en-bloc resection rate of EGC regardless of lesion size is higher than that observed with EMR [2]. The reported 5-year survival of ESD for EGC, which met the absolute and expanded indications, was over 95% [3,4]. According to the National Cancer Screening program of the republic of Korea, Korean adults over 40 years can receive endoscopic gastric cancer screening every other year.…”

Section: Introductionmentioning

confidence: 99%

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Preprocedural prediction of non-curative endoscopic submucosal dissection for early gastric cancer

et al. 2018

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Background and aimEndoscopic submucosal dissection (ESD) has been accepted as the treatment of choice for early gastric cancer (EGC) without lymph node metastasis. However, additional surgical gastrectomy should be considered after non-curative endoscopic resection. We aimed to evaluate the predictive factors associated with non-curative endoscopic resection.MethodsBetween November 2008 and June 2015, a retrospective study was conducted in a single, tertiary, referral hospital. A total of 596 EGC lesions resected by ESD were analyzed. Non-curative endoscopic resection was defined as the occurrence of lesions associated with piecemeal resection, positive resection margins, lymphovascular invasion, or lesions that did not meet the expanded indications for ESD.ResultsThe rate of non-curative endoscopic resection was 16.1%. The mean follow-up period was 35.3 ± 25.0 months. Associated predictive factors for non-curative endoscopic resection were female sex (OR, 2.470; p = 0.004), lesion size ≥ 20 mm (OR 3.714; p < 0.001), longer procedure time (OR 2.449, p = 0.002), ulceration (OR 3.538, p = 0.002), nodularity (OR 2.967, p<0.001), depression (OR 1.806, p = 0.038), undifferentiated carcinoma (OR 2.825, p = 0.031) and lesion located in the mid or upper third of stomach (OR 7.135 and OR 4.155, p<0.001, respectively). As the number of risk factors increased, the risk of non-curative ESD also increased.ConclusionsPrior to selection of ESD, the risks associated with non-curative ESD should be considered so that appropriate treatment modalities may be selected.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preprocedural prediction of non-curative endoscopic submucosal dissection for early gastric cancer

et al. 2018

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“…An endoscopic resection or wedge resection without lymphadenectomy is performed when patients show normal fasting serum gastrin levels and have a gastric NET of 2 cm or less on upper gastrointestinal endoscopy. For endoscopic resection, endoscopic mucosal resection (EMR) was performed until 2008 and endoscopic submucosal dissection (ESD) after 2008. Subtotal or total gastrectomy with radical D2 lymph node dissection was indicated for gastric NETs larger than 2 cm or for tumours with lymphovascular invasion on forceps biopsy, regardless of tumour grade.…”

Section: Methodsmentioning

confidence: 99%

“…Processing of surgical or endoscopic resection specimens in Samsung Medical Centre has been described in detail elsewhere. In the present study, diagnosis and grading of gastric NETs was done by two pathologists according to WHO 2010 classification: G1, mitotic count less than 2 per 10 high‐power fields (HPFs) and/or Ki‐67 index 2 per cent or less; G2, mitotic count 2–20 per 10 HPFs and/or Ki‐67 index 3–20 per cent; and G3, mitotic count over 20 per 10 HPFs and/or Ki‐67 index exceeding 20 per cent.…”

Section: Methodsmentioning

confidence: 99%

Clinicopathological features and outcome of type 3 gastric neuroendocrine tumours

Min

Hong

Lee

et al. 2018

British Journal of Surgery

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“…Surveillance endoscopy at an interval of ≤ 12 mo permitted the detection of lesions at an earlier stage[31]. For these reasons, the majority of authors recommend endoscopy exams with short time intervals after the endoscopic resection of early stage gastric cancer[32]. The incidence of gastric stump recurrence or metachronous cancer ranges between 1% and 7% depending on the study and geographical area[33].…”

Section: Methods Of Follow-upmentioning

confidence: 99%

Follow-up after curative resection for gastric cancer: Is it time to tailor it?

Aurello¹,

Petrucciani²,

Antolino³

et al. 2017

WJG

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There is still no consensus on the follow-up frequency and regimen after curative resection for gastric cancer. Moreover, controversy exists regarding the utility of follow-up in improving survival, and the recommendations of experts and societies vary considerably. The main reason to establish surveillance programs is to diagnose tumor recurrence or metachronous cancers early and to thereby provide prompt treatment and prolong survival. In the setting of gastric malignancies, other reasons have been put forth: (1) the detection of adverse effects of a previous surgery, such as malnutrition or digestive sequelae; (2) the collection of data; and (3) the identification of psychological and/or social problems and provision of appropriate support to the patients. No randomized controlled trials on the role of follow-up after curative resection of gastric carcinoma have been published. Herein, the primary retrospective series and systematic reviews on this subject are analyzed and discussed. Furthermore, the guidelines from international and national scientific societies are discussed. Follow-up is recommended by the majority of institutions; however, there is no real evidence that follow-up can improve long-term survival rates. Several studies have demonstrated that it is possible to stratify patients submitted to curative gastrectomy into different classes according to the risk of recurrence. Furthermore, promising studies have identified several molecular markers that are related to the risk of relapse and to prognosis. Based on these premises, a promising strategy will be to tailor follow-up in relation to the patient and tumor characteristics, molecular marker status, and individual risk of recurrence.

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Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer

Cited by 90 publications

References 25 publications

Preprocedural prediction of non-curative endoscopic submucosal dissection for early gastric cancer

Preprocedural prediction of non-curative endoscopic submucosal dissection for early gastric cancer

Clinicopathological features and outcome of type 3 gastric neuroendocrine tumours

Follow-up after curative resection for gastric cancer: Is it time to tailor it?

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