Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer

Hahn, Kyu Yeon; Park, Chan Hyuk; Lee, Yong Kang; Lee, Hyuk-Joon; Park, Jun Chul; Shin, Sung Kwan; Lee, Yong Chan; Kim, Wook; Cheong, Jae‐Ho; Hyung, Woo Jin; Noh, Sung Hoon; Lee, Sang Kil

doi:10.1007/s00464-017-5640-8

Cited by 85 publications

(75 citation statements)

References 40 publications

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“…Several studies have reported the risk of lymph node metastasis to be negligibly low in lesions that satisfy the aforementioned indications (0.0%-0.3%). [90][91][92] In addition, Korean studies reported no significant difference in the five-year survival rate between endoscopic resection and surgical resection (93.6%-96.4% vs. 94.2%-97.2%), [93][94][95] They also reported no significant difference in the 10-year survival rate between endoscopic resection and surgical resection (81.9% vs. 84.9%). 93 However, endoscopic resection had a higher fiveyear cumulative incidence of metachronous gastric cancer than surgical resection (5.8%-10.9% vs. 0.9%-1.1%).…”

Section: Statement G3: We Recommend Endoscopic Resection For Early Gamentioning

confidence: 97%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Section: Statement G3: We Recommend Endoscopic Resection For Early Gamentioning

confidence: 97%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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“…With the development of endoscopic therapy, most EGC can be effectively treated by minimum invasive endoscopic treatments, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which can better preserve gastric function and reduce complications and cost compared with surgical operation [4][5][6]. However, a meta-analysis showed that the tumor recurrence after ESD is higher than surgical resection [7], whose reasons are related to metachronous new primary tumors, non-curative ESD, synchronous multiple primary tumors [8], and occult lymph node metastasis (LNM) before the operation [9].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram for preoperative prediction of lymph node metastasis in early gastric cancer

et al. 2020

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Background: The status of lymph nodes in early gastric cancer is critical to make further clinical treatment decision, but the prediction of lymph node metastasis remains difficult before operation. This study aimed to develop a nomogram that contained preoperative factors to predict lymph node metastasis in early gastric cancer patients. Methods: This study analyzed the clinicopathologic features of 823 early gastric cancer patients who underwent gastrectomy retrospectively, among which 596 patients were recruited in the training cohort and 227 patients in the independent validation cohort. Significant risk factors in univariate analysis were further identified to be independent variables in multivariable logistic regression analysis, which were then incorporated in and presented with a nomogram. And internal and external validation curves were plotted to evaluate the discrimination of the nomogram. Results: Totally, six independent predictors, including the tumor size, macroscopic features, histology differentiation, P53, carbohydrate antigen 19-9, and computed tomography-reported lymph node status, were enrolled in the nomogram. Both the internal validation in the training cohort and the external validation in the validation cohort showed the nomogram had good discriminations, with a C-index of 0.82 (95%CI, 0.78 to 0.86) and 0.77 (95%CI, 0.60 to 0.94) respectively. Conclusions: Our study developed a new nomogram which contained the most common and significant preoperative risk factors for lymph node metastasis in patients with early gastric cancer. The nomogram can identify early gastric cancer patients with the high probability of lymph node metastasis and help clinicians make more appropriate decisions in clinical practice.

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“…The therapeutic decision for endoscopic versus surgical resection of early gastric carcinoma (EGC) relies upon the clinicopathological findings of the risk of lymph node metastasis (LNM). In EGC with no or minimal risk of LNM, endoscopic resection, especially endoscopic submucosal dissection (ESD), is preferred because it presents minimal injury to the patients, costs less and has a higher safety margin, with maximal preservation of gastric function and excellent long‐term prognosis, comparable with open surgical resection . In contrast, in EGC at a high risk of LNM, radical gastrectomy with nodal dissection is required to achieve curative survival outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…In EGC with no or minimal risk of LNM, endoscopic resection, especially endoscopic submucosal dissection (ESD), is preferred because it presents minimal injury to the patients, costs less and has a higher safety margin, with maximal preservation of gastric function and excellent long-term prognosis, comparable with open surgical resection. 1 In contrast, in EGC at a high risk of LNM, radical gastrectomy with nodal dissection is required to achieve curative survival outcomes. Thus, accurate determination of the risk of LNM is of paramount importance for optimal triage in EGC patients.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study

Chen

Wang

Cheng³

et al. 2017

J of Digest Diseases

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Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer

Abstract: Although EGC lesions had poorer features in the surgery group than in the ESD group, ESD was comparable to surgery for EGCs that fulfilled the expanded indication of ESD, with lower rates of acute complication and comparable overall survival.

Cited by 85 publications

References 40 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Development and validation of a nomogram for preoperative prediction of lymph node metastasis in early gastric cancer

Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study

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