Endoscopic submucosal dissection for residual early gastric cancer after endoscopic submucosal dissection

Higashimaya, Makoto; Oka, Shiro; Tanaka, Shinji; Numata, Norifumi; Sanomura, Yoji; Yoshida, Shigeto; Arihiro, Koji; Chayama, Kazuaki

doi:10.1016/j.gie.2012.09.003

Cited by 25 publications

(25 citation statements)

References 38 publications

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“…ESD procedure ESD was performed with a conventional single-channel endoscope (GIF-450RD5, FUJIFILM Medical, Tokyo, Japan; GIF-H260, -H260Z, or -Q260J, Olympus, Tokyo, Japan) or a two-channel endoscope (GIF-450D5, FUJI-FILM Medical; or 2TQ260M; Olympus), as reported previously [5,6,8,9,13]. Between April 2005 and September 2009, we identified the tumor demarcation line (DL) by white light endoscopy and chromoendoscopy.…”

Section: Patientsmentioning

confidence: 99%

“…Endoscopic submucosal dissection (ESD) is widely accepted for early gastric cancer (EGC), and it can be performed regardless of tumor size, location, or fibrosis [1][2][3][4][5][6][7][8][9][10][11]. According to the Japanese Gastric Cancer Association (JGCA), [12] the absolute indication for curative ESD are well-or moderately differentiated intramucosal adenocarcinoma B2 cm in diameter without ulceration and absence of lymph node (LN) metastasis and lymphatic vessel invasion.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and management of positive horizontal margin in early gastric cancer resected by en bloc endoscopic submucosal dissection

et al. 2014

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Background Although endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric cancer (EGC), there is no consensus regarding the management of positive horizontal margin (HM) despite en bloc ESD. The aim of the current study was to identify the risk factors and optimal management of positive HM in EGCs resected by en bloc ESD. Methods A total of 890 consecutive patients with 1,053 intramucosal EGCs resected by en bloc ESD between April 2005 and June 2011. Clinicopathological data were retrieved retrospectively to assess the positive HM rate, local recurrence rate, risk factors for positive HM, and outcomes of treatment for local recurrent tumor. Positive HM was defined as a margin with direct tumor invasion (type A), the presence of cancerous cells on either end of 2-mm-thick cut sections (type B), or an unclear tumor margin resulting from crush or burn damage (type C).Results The positive HM rate was 2.0 % (21/1,053). The local recurrence rate was 0.3 % (3/1,053). All local recurrent tumors were intramucosal carcinomas, and were resected curatively by re-ESD. Multivariate analysis with logistic regression showed tumor location in the upper third of the stomach and lesions not matching the absolute indication to be independent risk factors for positive HM. Conclusion The risk factors for HM positivity in cases of EGC resected by en bloc ESD are tumor location in the upper third of the stomach and dissatisfaction of the absolute indication for curative ESD.

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Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors and management of positive horizontal margin in early gastric cancer resected by en bloc endoscopic submucosal dissection

et al. 2014

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“…status after EMR are generally discovered as intramucosal neoplasms during followup care, and in many cases, clinical rescue is possible through endoscopic treatment, including late sESD [28,29]; however, to the best of our knowledge, there has been only one case study reporting the efficacy of late sESD for post-ESD recurrent tumors [30]. Despite the technical difficulty of dissecting the submucosal layer correctly when there is rigid scar formation after the initial ESD, the results of the present study confirmed the feasibility and curability of late sESD, and the lack of severe complications, agreeing with previous findings [30].…”

Section: Resultsmentioning

confidence: 99%

Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection

et al. 2013

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Background Endoscopic submucosal dissection (ESD) is a widely accepted technique for the management of gastric tumors. However, residual or recurrent tumors can occur after ESD; currently, there is no adequate management strategy for these tumors. Thus, the aim of the present study was to establish a strategy of secondary ESD (sESD) for cases with positive lateral margins (LM?), which cause post-ESD residual or recurrent tumors. Methods Fifty-three lesions that were subjected to ESD were diagnosed as LM? with suspected local residual tumor. The short-and long-term outcomes of early sESD (performed shortly after the initial ESD in LM? cases to prevent local recurrence) were retrospectively compared with those of late sESD (performed after the detection of recurrent tumors). Results Of the 53 LM? cases, the local residual positive rate was 38.5 % (10/26) in those undergoing early sESD or additional surgery and the local recurrence rate was 29.6 % (8/27) in those that were not treated. Thus, the overall incidence of residual or recurrent tumors in LM? cases was 34.0 % (18/53). Both early and late sESD had favorable outcomes with no severe complications: 100 % of early sESD resections were curative, compared with 86.7 % of late sESD resections, over the course of a mean (±SD) observation period of 50.8 ± 16.7 months. The performance of early sESD was significantly greater than that of late sESD (in terms of dissection speed). Conclusions Early sESD is more reliable than late sESD as a therapeutic strategy for salvaging residual tumors and for preventing recurrence. However, if a tumor has already recurred, late sESD remains useful.

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“…Laparoscopic wedge resection, intragastric surgery, and laparoscopic-associated distal gastrectomy are some of the invasive treatment options for locally recurrent gastric cancers [26][27][28] . A recent report by Higashimaya et al [25] documented re-ESD as a minimally invasive, safe and effective procedure in a series of recurrent EGCs. In this study, re-ESD was successfully performed by en bloc resection with free lateral and vertical margins without any complications.…”

Section: Discussionmentioning

confidence: 99%

“…While this procedure typically results in histologically complete resections, cases of locally recurrent gastric tumors have occurred, with reported incidence rates between 0% and 3% [14][15][16]25] . Laparoscopic wedge resection, intragastric surgery, and laparoscopic-associated distal gastrectomy are some of the invasive treatment options for locally recurrent gastric cancers [26][27][28] .…”

Section: Discussionmentioning

confidence: 99%

Repeat endoscopic submucosal dissection for recurrent gastric cancers after endoscopic submucosal dissection

Shimamura

Ishii

Nakano

et al. 2013

WJGE

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AIM:To clarify the safety and efficacy of repeat endoscopic submucosal dissection (re-ESD) for locally recurrent gastric cancers after ESD. METHODS:A retrospective evaluation was performed of the therapeutic efficacy, complications and followup results from ESD treatment for early gastric cancers in 521 consecutive patients with 616 lesions at St. Luke`s International Hospital between April 2004 and November 2012. In addition, tumor size, the size of resected specimens and the operation time were compared between re-ESD and initial ESD procedures. A flex knife was used as the primary surgical device and a hook knife was used in cases with severe fibrosis in the submucosal layer. Continuous variables were analyzed using the non-parametric Mann-Whitney U test and are expressed as medians (range). Categorical variables were analyzed using a Fisher's exact test and are reported as proportions. Statistical significance was defined as a P -value less than 0.05. RESULTS:The number of cases in the re-ESD group and the initial ESD group were 5 and 611, respectively. The median time interval from the initial ESD to re-ESD was 14 (range, 4-44 mo). En bloc resection with free lateral and vertical margins was successfully performed in all re-ESD cases without any complications. No local or distant recurrence was observed during the median follow-up period of 48 (range, 11-56 mo). Tumor size was not significantly different between the re-ESD group and the initial ESD group (median 22 mm vs 11 mm, P = 0.09), although the size of resected specimens was significantly larger in the re-ESD group (median 47 mm vs 34 mm, P < 0.05). There was a nonsignificant increase observed in re-ESD operation time compared to initial ESD (median 202 min vs 67 min, respectively, P = 0.06). CONCLUSION:Despite the low patient number and short follow-up, the results suggest that re-ESD is a safe and effective endoscopic treatment for recurrent gastric cancer after ESD.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Endoscopic submucosal dissection; Recurrent gastric cancer; Gastric cancer; Endoscopic mucosal resection; Therapeutic endoscopy Core tip: Although endoscopic submucosal dissection (ESD) is widely accepted as one of the standard treatments for early gastric cancers, there are few reports on re-ESD in the literature. This study clarifies that re-ESD is a safe and effective endoscopic treatment for locally recurrent gastric cancers after ESD.

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Endoscopic submucosal dissection for residual early gastric cancer after endoscopic submucosal dissection

Cited by 25 publications

References 38 publications

Risk factors and management of positive horizontal margin in early gastric cancer resected by en bloc endoscopic submucosal dissection

Risk factors and management of positive horizontal margin in early gastric cancer resected by en bloc endoscopic submucosal dissection

Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection

Repeat endoscopic submucosal dissection for recurrent gastric cancers after endoscopic submucosal dissection

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