Prediction model for non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer

Kim, Eun Hye; Park, Jun Chul; Song, In Ji; Kim, Yeong Jin; Joh, Dong Hoo; Hahn, Kyu Yeon; Lee, Yong Kang; Kim, Ha Yan; Lee, Hyuk-Joon; Shin, Sung Kwan; Lee, Sang Kil

doi:10.1016/j.gie.2016.10.018

Cited by 43 publications

(47 citation statements)

References 24 publications

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“…The higher the score, the higher the risk of NCR. 24 In addition, a study reported that a tumor size of >2 cm, a superficial elevated and depressed type, and an undifferentiated type were risk factors for NCR. 25 In addition to the characteristics of the lesion at the time of the procedure, the effects of an operator' s endoscopic technique and the pre-and post-procedure discrepancies in NCR were analyzed in one study.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea

et al. 2020

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Background/Aims: The purpose of this study was to investigate the risk factors and long-term clinical outcomes of non-curative resection (NCR) in a large-scale patient population. Methods: We retrospectively analyzed the clinical data of 3,094 patients who underwent endoscopic submucosal dissection (ESD) of early gastric cancer from March 2005 to March 2018 at 13 institutions in Korea. We analyzed the risk factors for NCR and the survival between patients with curative resection and those with NCR with no additional treatment. Results: The NCR rate was 21.4% (661/3,094). In multivariate regression analysis, the risk factors affecting NCR with ESD were old age, undifferentiated tumor, tumor location in the upper body, tumor size ≥2 cm, and presence of an ulcer. In Cox proportional hazard regression analysis, tumor size ≥2 cm, submucosal invasion, positive horizontal margin, and lymphovascular invasion were risk factors for local recurrence. In Kaplan-Meier analysis, there was no statistically significant difference in the overall survival between the two groups (log-rank p=0.788). However, disease-specific survival was significantly lower in the NCR group (log-rank p=0.038). Conclusions: Clinicians should be aware of the risk factors for NCR and local recurrence after ESD for early gastric cancer, and should consider providing additional treatment after NCR.

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea

et al. 2020

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“…The Japanese Gastric Cancer Association defined a curative resection as an en-bloc resection of EGC that showed no marginal involvement and met the expanded indication [6]. Despite the higher en-bloc resection rate, up to 16.5% of patients who underwent ESD were reported to have a non-curative endoscopic resection [7]. After non-curative endoscopic resection, additional surgical treatment should be performed because of the high risk of local recurrence or lymph node metastasis.…”

Section: Introductionmentioning

confidence: 99%

Preprocedural prediction of non-curative endoscopic submucosal dissection for early gastric cancer

et al. 2018

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Background and aimEndoscopic submucosal dissection (ESD) has been accepted as the treatment of choice for early gastric cancer (EGC) without lymph node metastasis. However, additional surgical gastrectomy should be considered after non-curative endoscopic resection. We aimed to evaluate the predictive factors associated with non-curative endoscopic resection.MethodsBetween November 2008 and June 2015, a retrospective study was conducted in a single, tertiary, referral hospital. A total of 596 EGC lesions resected by ESD were analyzed. Non-curative endoscopic resection was defined as the occurrence of lesions associated with piecemeal resection, positive resection margins, lymphovascular invasion, or lesions that did not meet the expanded indications for ESD.ResultsThe rate of non-curative endoscopic resection was 16.1%. The mean follow-up period was 35.3 ± 25.0 months. Associated predictive factors for non-curative endoscopic resection were female sex (OR, 2.470; p = 0.004), lesion size ≥ 20 mm (OR 3.714; p < 0.001), longer procedure time (OR 2.449, p = 0.002), ulceration (OR 3.538, p = 0.002), nodularity (OR 2.967, p<0.001), depression (OR 1.806, p = 0.038), undifferentiated carcinoma (OR 2.825, p = 0.031) and lesion located in the mid or upper third of stomach (OR 7.135 and OR 4.155, p<0.001, respectively). As the number of risk factors increased, the risk of non-curative ESD also increased.ConclusionsPrior to selection of ESD, the risks associated with non-curative ESD should be considered so that appropriate treatment modalities may be selected.

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“…Some patients met the extended criteria before ESD, but they did not meet the expanded criteria on the final histopathologic result after ESD. These patients require additional surgery after ESD [9]. In a recent study, the curative resection rate was reported to be 81.9% in patients who underwent ESD for EGC [10].…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of regional lymph node enlargement in patients with EGC within the expanded criteria for ESD

et al. 2020

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AbstractsBackground: Lymph node (LN) metastasis is negligible in early gastric cancer (EGC) within expanded criteria for endoscopic submucosal dissection (ESD). However, regional lymph nodes in abdominal CT scans are sometimes enlarged in patients with EGC within the expanded criteria for endoscopic submucosal dissection (ESD). In this study, we investigated the clinical significance of regional lymph node enlargement on abdominal CT scan in patients with EGC within the expanded criteria for ESD. Methods: From December 2010 to April 2015, among 301 patients with EGC within the ESD expanded criteria, 47 patients with regional lymph node enlargement shown by abdominal CT scan were prospectively enrolled. We performed surgical resection or periodic follow-up with abdominal CT scans and upper endoscopy every 6 months to evaluate whether the enlarged lymph nodes are due to metastasis or a reactive change. Results: The mean age of the 47 patients (38 males, 9 female) was 64.8 years. The enlarged lymph nodes were usually single (26/47, 44.6%) and sized as follows: 11 nodes were ≤ 5 mm, 19 were 6-10 mm, and 17 were ≥ 10 mm. Four of the 47 patients initially underwent surgical resection, and 8 patients underwent surgical resection after ESD. However, there was no lymph node metastasis in surgical specimens. Thirty-five patients received ESD and periodically followed up at a median duration of 56 months (IQR: 44-59 month). The enlarged lymph node disappeared in 12 of 35 patients, decreased in 9 patients and remained the same size in 13 patients, and increased in 1 patient. Conclusion: Regional lymph node enlargement on abdominal CT scan in patients within expanded criteria for ESD of ECG may be not due to metastasis but a reactive change.

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Prediction model for non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer

Cited by 43 publications

References 24 publications

Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea

Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea

Preprocedural prediction of non-curative endoscopic submucosal dissection for early gastric cancer

Clinical significance of regional lymph node enlargement in patients with EGC within the expanded criteria for ESD

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