Local excision for early gastric cancers.

Sasako, Mitsuru; Kinoshita, Taira; Maruyama, Kouichi; Okabayashi, K.; Tajiri, Hisao; Yoshida, Shigeaki; Yamaguchi, Hideyo; Saitoh, Daizoh; Oguro, Yanao; Ishikawa, Tsutomu; Matsue, H; Yamada, Tatsuya

doi:10.5833/jjgs.23.2191

Cited by 8 publications

(6 citation statements)

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“…In addition, more importantly, the 5-year relative survival rate of EGC patients undergoing curative ESD for absolute indications or for expanded indications in the present study was almost 100 %, which demonstrated that curative ESD can enable 5-year survival rates comparable to those of persons of matched sex and age from the general population to be achieved [14][15][16][17]. Furthermore, the 5-year disease-specific survival rate of 99.9 % noted in the present study was also comparable to the previously reported rate of 99.3 % for mucosal EGC patients treated by gastrectomy with LN dissection [22]. Therefore, the present study is very significant in that it allows precise clarification of the effectiveness of ESD for EGC from the perspective of long-term survival.…”

Section: Discussionsupporting

confidence: 79%

High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

et al. 2015

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Background Endoscopic submucosal dissection (ESD) has been used to treat patients with early gastric cancers (EGCs), including large and ulcerative lesions. Few published data exist on the long-term outcomes of this treatment with median follow-up periods of over 5 years; we therefore aimed to assess the long-term outcomes of EGC patients undergoing ESD. Methods A total of 1,956 consecutive patients with 2,210 EGC lesions at initial onset underwent ESD with curative intent at our hospital from 1999 to 2006. We performed a retrospective analysis of the 5-year survival of EGC patients undergoing curative ESD for absolute indications or for expanded indications. Results For the pathological curability, curative ESD for absolute indications, curative ESD for expanded indications of differentiated-type EGC, and curative ESD for undifferentiated-type EGC were achieved in 781, 713, and 43 patients, respectively. The median follow-up period was 83.3 months. Among the 1,537 patients, there were only two patients with recurrence, including one who developed a regional lymph node (LN) metastasis and one who developed a distant LN metastasis with local recurrence resulting in gastric cancer-related death. Seven died from metachronous gastric cancers. The 5-year rates of overall survival, disease-specific survival, and relative survival were 92.6, 99.9, and 105.0 %, respectively.Conclusions Based on the high rate of 5-year survival among EGC patients undergoing curative ESD for absolute indications or for expanded indications in the largest patient series with a median follow-up period of over 5 years, ESD could be employed as a standard treatment for EGC lesions.

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Section: Discussionsupporting

confidence: 79%

High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

et al. 2015

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“…Patients' quality of life is one of the most important issues in EGC treatment, because the prognosis of EGC is favorable [13]. Differentiating endoscopically resectable M-SM1 gastric cancers from surgically resectable SM2 lesions is of great significance, given the low risk of lymph node metastases with the former.…”

Section: Discussionmentioning

confidence: 99%

Depth-predicting score for differentiated early gastric cancer

Abe

Oda

Shimazu³

et al. 2011

Gastric Cancer

102

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Background Intramucosal and minute submucosal (M-SM1; \500 lm in depth) differentiated gastric cancers, which have a negligible risk of lymph node metastasis, are the targets for endoscopic resection. However, there have been few reports about the endoscopic distinction between these cancers and cancers with deeper submucosal invasion (SM2; C500 lm in depth). The aim of this retrospective study was to analyze the differences in the endoscopic features between M-SM1 and SM2 cancers, and to develop a simple scoring model to predict the depth of these early gastric cancers. Methods We analyzed 853 differentiated early gastric cancers treated endoscopically or surgically as a derivation group. Endoscopic images were reviewed to determine the relationship between depth of invasion and the following endoscopic features: tumor location, macroscopic type, tumor size, and endoscopic findings (remarkable redness, uneven surface, margin elevation, ulceration, and enlarged folds). Secondly, we created a depth-predicting model based on the obtained data and applied the model to 211 validation samples.Results On logistic regression analysis, tumor size more than 30 mm, remarkable redness, uneven surface, and margin elevation were significantly associated with deeper submucosal cancers. A depth-predicting score was created by assigning 2 points for margin elevation and tumor size more than 30 mm, and 1 point for each of the other endoscopic features. When validation lesions of 3 points or more were diagnosed as deeper submucosal cancers, the sensitivity, specificity, and accuracy as evaluated by three endoscopists were 29.7-45.9, 93.1-93.7, and 82.5-84.8%, respectively. Conclusions The depth-predicting score could be useful in the decisions on treatment strategy for differentiated M-SM1 early gastric cancers.

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“…Therefore, simple follow-up may be an acceptable management option instead of additional gastrectomy in noncurative ESD patients with lower survival HM horizontal margin, M mucosa, NS Not significant, SM submuscosal, SM1 tumor infiltration into the submucosal layer less than 500 lm from the muscularis mucosae, SM2 tumor infiltration into the submucosal layer 500 lm or more from the muscularis mucosae, VM vertical margin a The 95 % confidence interval is given in parentheses rates, such as elderly patients and/or patients with severe concomitant disease. On the other hand, additional gastrectomy with lymphadenectomy may be more appropriate than simple follow-up in noncurative ESD patients without concomitant disease and who are young enough to undergo recommended surgical interventions according to the Japanese gastric cancer treatment guidelines because of the favorable outcomes of surgical treatment [4,[28][29][30]. Thus, it is necessary to assess the clinicopathological factors associated with LN and/or distant metastases and gastriccancer-related death to identify noncurative ESD patients for whom additional gastrectomy should be particularly performed and to establish the evidence for decision making on additional gastrectomy in noncurative ESD patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Background Clinical outcomes of early gastric cancer (EGC) patients after noncurative endoscopic submucosal dissection (ESD) have not been fully elucidated; we therefore aimed to clarify these outcomes. Methods A total of 3058 consecutive patients with 3474 clinically diagnosed EGCs at initial onset underwent ESD with curative intent at our hospital between 1999 and 2010. We retrospectively assessed the following clinical outcomes of noncurative gastric ESD patients with a possible risk of lymph node (LN) metastasis by dividing patients into two groups with different treatment strategies (additional gastrectomy and simple follow-up): presence of LN metastasis at the time of gastrectomy, incidence of LN and distant metastases during the follow-up period, clinicopathological factors associated with metastasis, and 5-year disease-specific survival (DSS). Results After exclusion of 75 noncurative ESD patients with only a positive horizontal margin, 569 noncurative ESD patients with a possible risk of LN metastasis were identified. Among the 356 patients undergoing additional gastrectomy, LN metastasis was identified in 18 patients. A positive vertical margin with submucosal invasion (odds ratio 3.6) and lymphovascular invasion (odds ratio 3.5) were significantly associated with LN metastasis. The 5-year DSS rate was 98.8 %. Among the 212 patients who underwent simple follow-up, LN and/or distant metastases were found in eight patients. In this group, lymphovascular invasion (hazard ratio 6.6) was significantly associated with metastasis with a 5-year DSS rate of 96.8 %.Conclusions Additional gastrectomy should be performed particularly in noncurative gastric ESD patients with lymphovascular invasion or a positive vertical margin with submucosal invasion.

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Local excision for early gastric cancers.

Cited by 8 publications

References 0 publications

High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection

Depth-predicting score for differentiated early gastric cancer

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

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