Clinical outcomes of early gastric cancer with lymphovascular invasion or positive vertical resection margin after endoscopic submucosal dissection

Abstract

Close surveillance may be suggested as an option for EGC patients for whom a surgical approach is difficult, who exhibit a positive vertical margin after ESD, and who have no lymphovascular or deep submucosa invasion after ESD.

Clinical outcomes of early gastric cancer patients after noncurative endoscopic submucosal dissection in a large consecutive patient series

“…Although several studies have described the clinical outcomes of noncurative gastric ER patients, the definition of noncurative gastric ER differs between studies; most of these studies have assessed the clinical outcomes of noncurative gastric ER patients in small numbers of patients without detailed statistical analysis [15][16][17][18][19][20][21][22][23][24][25]. For example, noncurative gastric ER was defined according to the Japanese gastric cancer treatment guidelines in some studies but was defined according to the original criteria in others [4,[15][16][17][18][19][20][21][22][23][24][25]. In addition, with the exception of two studies by Oda et al [15] and Yang et al [16], fewer than 200 noncurative gastric ER cases were included in previous studies [15][16][17][18][19][20][21][22][23][24][25].…”

“…For example, noncurative gastric ER was defined according to the Japanese gastric cancer treatment guidelines in some studies but was defined according to the original criteria in others [4,[15][16][17][18][19][20][21][22][23][24][25]. In addition, with the exception of two studies by Oda et al [15] and Yang et al [16], fewer than 200 noncurative gastric ER cases were included in previous studies [15][16][17][18][19][20][21][22][23][24][25]. To the best of our knowledge, the present study is the largest study demonstrating the clinical outcomes of more 500 noncurative gastric ESD patients, including long-term survival outcomes with a median follow-up period of more than 5 years and clinicopathological factors associated with metastasis and gastric-cancer-related death.…”

“…In addition, Hoteya et al [22] described that gastric-cancer-related deaths and OS rates did not differ significantly between observation and additional surgery groups; however the number of noncurative gastric ESD patients included in this study was also less than 200 (165 patients). The remaining studies have predominantly focused on tumor recurrence after noncurative ER without detailed analysis of survival outcomes [23][24][25]. Accordingly, the long-term survival outcomes of noncurative gastric ER patients have not been fully elucidated.…”

“…In general, noncurative ESD patients with a possible risk of LN metastasis are treated with additional gastrectomy; however, a relatively small number of these patients are selected to undergo simple follow-up without surgical treatment for various reasons [15]. Although several studies have reported clinical outcomes of noncurative gastric endoscopic resection (ER) patients, most of these reports have described clinical outcomes in a small number of patients without detailed assessments, with only two previous studies including more 200 noncurative gastric ER cases [15][16][17][18][19][20][21][22][23][24][25]. Therefore, we attempted to clarify the clinical outcomes of noncurative gastric ESD patients with a possible risk of LN metastasis by dividing the patients according to the following two treatment strategies on the basis of data from a large consecutive patient series: additional gastrectomy and simple follow-up.…”

Predictors of lymph node metastasis and residual tumor in early gastric cancer patients after noncurative endoscopic resection: a systematic review and meta-analysis

“…53 Interestingly, Noh et al suggested that close surveillance might be a feasible strategy for patients with EGC who present positive vertical margin without LVI or deep submucosa invasion, especially for whom surgery might be risky. 54 A scoring system, named as eCura, was established to categorize patients into three risk groups in order to address the risk of LNM in Japan. In its validation stage, noncurative ESD followed by additional surgery was recommended for patients in the high LNM risk group, whose 5-year cancer-specific survival appeared to be 90.1%.…”