Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer

Eom, Bang Wool; Kim, Young Il; Kim, Kwang Hee; Yoon, Hong Man; Cho, Soo‐Jeong; Lee, Jong Yeul; Kim, Chan Gyoo; Kook, Myeong–Cherl; Nam, Byung–Ho; Choi, Il Ju

doi:10.1016/j.gie.2016.07.036

Cited by 47 publications

(39 citation statements)

References 31 publications

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“…Based on our finding of operative safety after ESD, the ESD indication may be expanded. However, the indication for ESD should be decided considering the safety of additional surgery and the long-term oncologic outcomes [7]. …”

Section: Discussionmentioning

confidence: 99%

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The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer

et al. 2017

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PurposeEndoscopic submucosal dissection (ESD) in early gastric cancer causes an artificial gastric ulcer and local inflammation that has a negative intraprocedural impact on additional laparoscopic gastrectomy in patients with noncurative ESD. In this study, we analyzed the effect of ESD on short-term surgical outcomes and evaluated the risk factors.Materials and MethodsFrom January 2003 to January 2013, 1,704 patients of the National Cancer Center underwent laparoscopic gastrectomy with lymph node dissection because of preoperative stage Ia or Ib gastric cancer. They were divided into 2 groups: (1) with preoperative ESD or (2) without preoperative ESD. Clinicopathologic factors and short-term surgical outcomes were retrospectively evaluated along with risk factors such as preoperative ESD.ResultsSeveral characteristics differed between patients who underwent ESD-surgery (n=199) or surgery alone (n=1,505). The mean interval from the ESD procedure to the operation was 43.03 days. Estimated blood loss, open conversion rate, mean operation time, and length of hospital stay were not different between the 2 groups. Postoperative complications occurred in 23 patients (11.56%) in the ESD-surgery group and in 189 patients (12.56%) in the surgery-only group, and 3 deaths occurred among patients with complications (1 patient [ESD-surgery group] vs. 2 patients [surgery-only group]; P=0.688). A history of ESD was not significantly associated with postoperative complications (P=0.688). Multivariate analysis showed that male sex (P=0.008) and laparoscopic total or proximal gastrectomy (P=0.000) were independently associated with postoperative complications.ConclusionsESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.

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Section: Discussionmentioning

confidence: 99%

“…Noncurative factors after an ESD procedure are submucosal invasion (sm1) >500 μm, lymphovascular invasion, undifferentiated histology, large tumor size, and a tumor-involved margin [67]. Surgical treatment is recommended for patients of noncurative factors.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer

et al. 2017

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“…3), additional surgery is recommended for patients who underwent non-curative endoscopic resection for gastric cancer (34). Previous studies reported 3%–18% of lymph node metastases in patients with tumors out of indication, and standard gastrectomy with D1+ lymph node dissection is recommended for these patients (35-40). However, the majority of these patients have no lymph node metastasis and additional surgery is considered as overtreatment.…”

Section: Application Of Sn Navigation Surgery After Non-curative Endomentioning

confidence: 99%

Current status and challenges in sentinel node navigation surgery for early gastric cancer

Eom¹,

Kim²,

Yoon³

et al. 2017

Chinese Journal of Cancer Research

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Although a number of feasibility studies for sentinel node (SN) concepts in gastric cancer have been conducted since 2000, there remains a debate regarding detailed detection techniques and oncological safety. Two important multicenter phase II clinical trials were performed in Japan that used different methods and reached different conclusions; one confirmed acceptable results with a false-negative rate of 7%, and the other showed an unacceptably high false-negative rate of 46.4%. The Sentinel Node Oriented Tailored Approach (SENORITA) trial is a multicenter randomized controlled phase III trial being performed in Korea. Patient enrollment is now complete and the long-term results are currently awaited. Recently, an image-guided SN mapping technique using infrared ray/fluorescence was introduced. This method might be a promising technology because it allows the clear visualization of SNs. With regard to the primary tumor, the non-exposed endoscopic wall-inversion surgery technique and non-exposure endolaparoscopic full-thickness resection with simple suturing technique have been reported. These methods prevent abdominal infection and tumor seeding and can be good alternatives to conventional laparoscopic gastric wedge resection. For indications, SN navigation surgery can be extended to patients who underwent non-curative endoscopic resection. Although a few studies have been performed on these patients, sentinel concepts may be beneficial to patients as they omit the need for additional gastrectomy. SN navigation surgery can lead to actual organ-preserving surgery and plays a key role in improving the quality of life of patients with early gastric cancer in the future.

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“…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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Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer

Cited by 47 publications

References 31 publications

The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer

The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer

Current status and challenges in sentinel node navigation surgery for early gastric cancer

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

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