What are the risk factors for residual tumor cells after endoscopic complete resection in gastric epithelial neoplasia?

Yun, Gak Won; Kim, Joo Hang; Lee, Yong C.han; Lee, Sang K.il; Shin, Sung Kwan; Park, Jun C.hul; Lee, Hyuk-Joon; Park, Jae J.un; Youn, Young Hoon; Park, Hyojin

doi:10.1007/s00464-014-3693-5

Cited by 12 publications

(15 citation statements)

References 17 publications

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“…Our results show that SE spreading of early gastric SRC can reach up to 6,000 μm from the terminal end of the surface lesion. A previous Korean study suggested that the safety margin <3 mm was a risk factor of local recurrence [20]. Eight patients with SRC were enrolled in this study, and 6 patients (75%) showed residual tumors.…”

Section: Discussionmentioning

confidence: 96%

Subepithelial Spread of Early Gastric Signet Ring Cell Carcinoma: How Far They Can Reach?

Lee

Kang

Kim

et al. 2020

Dig Dis

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Introduction: Although signet ring cell carcinoma (SRC) is a poorly differentiated cancer subtype, recent studies suggest that endoscopic resection can be applied in small, mucosal early gastric SRC. However, other studies report frequent positive lines at the lateral resection margin after endoscopic treatment. Subepithelial spread beneath normal mucosa can exist in SRC, and such lesions may be the cause of positive margins after endoscopic resection. Thus, we conducted a retrospective study in order to evaluate the significance of subepithelial spread in early gastric SRC. Method: Medical records of early gastric SRC patients who underwent surgery or endoscopic resection from January 2011 to December 2016 at a single tertiary hospital (Daejeon, South Korea) were reviewed to examine subepithelial spread and clinical datum. Two expert pathologists reviewed all pathologic specimens, and only patients showing a pure SRC component were included. Results: Eighty-six patients were initially enrolled, and subepithelial spread existed in 62 patients (72.1%). The mean distance of subepithelial spread was 1,132.1 µm, and the maximal distance was 6,000 μm. Only discoloration was significantly associated with the presence of a subepithelial spread (p < 0.05, χ2 test, and logistic regression test). Distance of subepithelial spread did not correlate with total lesion size. Conclusion: Subepithelial spread of early gastric SRC occurs frequently and can reach up to 6 mm. Lesion discoloration may be associated with the presence of subepithelial spread. Our results suggest that careful decision of the margin is needed when performing endoscopic resection of early gastric SRC.

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Section: Discussionmentioning

confidence: 96%

Subepithelial Spread of Early Gastric Signet Ring Cell Carcinoma: How Far They Can Reach?

Lee

Kang

Kim

et al. 2020

Dig Dis

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“…After a careful revision of the endoscopic and histological records, male sex was identified in both cases as well as narrow lateral margin on the first lesion and extensive atrophic gastritis on the second, all risk factors for local recurrence [22, 23]. …”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Costa

Ferreira

Leal

et al. 2018

GE Port J Gastroenterol

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Background: The emergence of endoscopic submucosal dissection (ESD) made possible en bloc resection of neoplastic gastric lesions, regardless of lesion size, with reduced rates of complications and recurrence. This technique has become the preferred method for curative resection, instead of conventional endoscopic mucosal resection and surgery, when distant metastases have negligible risk. In Western countries experience with this technique has evolved quickly, with an increasing number of case series reported in the literature. This study aims to report the short- and long-term outcomes of ESD in gastric epithelial neoplastic lesions by a single operator in a Portuguese centre. Methods: A retrospective analysis of all gastric ESDs in a tertiary specialised unit during a 5-year period, between May 2012 and September 2017, was performed. Results: A total of 114 ESDs of gastric epithelial lesions were performed during this period; 96.5% of them were removed en bloc and 87.6% with R0 resection. A curative treatment was achieved in 83.2% of the cases. Complications occurred in 13.2% of the procedures, including early and delayed bleeding in 12 patients (10.5%) and one perforation (0.9%). With a median follow-up period of 12 months (interquartile range [IQR] = 18), 6 cases of recurrence at the previous ESD site were diagnosed: 4 residual lesions and 2 local recurrences in previous R0 resections. Residual lesions occurred more often in patients with larger lesions (median = 40.0 mm, IQR = 26 vs. median = 20.0 mm, IQR = 15, p = 0.008) and with positive horizontal margins (HMs) after resection (50.0 vs. 0.0%, Fisher exact test, p < 0.001). The cumulative incidence of metachronous gastric lesions at 34 months was 16.1%. All new lesions were effectively treated using an endoscopic technique. The disease-specific survival at 12 months was 100%. Conclusion: This study showed that ESD is an effective resection technique for gastric lesions with a good safety profile, confirming other European series. Regardless, high en bloc resection positive HM is still a problem in some specimens resected by ESD. Endoscopic surveillance can detect local recurrence and new lesions during early stages, potentially treatable by endoscopy.

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“…To investigate the optimal pathological safety margin after ER, it is important to analyze risk factors for residual tumors in cases of completely resected EGC after ER. According to the study, a safety margin of <3 mm (odds ratio [OR], 13.8), PD (OR, 16.3), and SRC (OR, 9.8) were significantly associated with residual tumors after ER [38]. That is, UD-EGC including both PD and SRC is an independent risk factor for the presence of residual tumor cells after negative resected margins are found in ER specimens.…”

Section: Situation After Er: Mixed Histology and Safety Marginmentioning

confidence: 99%

“…That is, UD-EGC including both PD and SRC is an independent risk factor for the presence of residual tumor cells after negative resected margins are found in ER specimens. Furthermore, the pathological safety margin after ER may be >3 mm [38]. This safety margin can be important, especially in cases of UD-EGC.…”

Section: Situation After Er: Mixed Histology and Safety Marginmentioning

confidence: 99%

Strategy for Curative Endoscopic Resection of Undifferentiated-Type Early Gastric Cancer

Kim

2019

Clin Endosc

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Endoscopic resection (ER) of undifferentiated-type early gastric cancer (UD-EGC) has a lower curative resection (CR) rate than differentiated-type EGC. However, if UD-EGC is curatively resected using ER, long-term outcomes can be favorable. Thus, the strategy for CR by ER is important in UD-EGC. To achieve CR in UD-EGC, biological behaviors including tumor growth patterns must be considered. This review aims to describe what is important for curative ER of UD-EGC.

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What are the risk factors for residual tumor cells after endoscopic complete resection in gastric epithelial neoplasia?

Cited by 12 publications

References 17 publications

Subepithelial Spread of Early Gastric Signet Ring Cell Carcinoma: How Far They Can Reach?

Subepithelial Spread of Early Gastric Signet Ring Cell Carcinoma: How Far They Can Reach?

Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre

Strategy for Curative Endoscopic Resection of Undifferentiated-Type Early Gastric Cancer

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