Relevant risk factors for positive lateral margin after en bloc endoscopic submucosal dissection for early gastric adenocarcinoma

Fu, Qing Yan; Cui, Yun; Li, Xiao Bo; Chen, Ping; Chen, Xiao Yu

doi:10.1111/1751-2980.12342

Cited by 13 publications

(6 citation statements)

References 20 publications

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“…Therefore, it can also provide some reference significance for endoscopists. Large tumors and proximal gastric location of EGCs have been reported as risk factors for non-curative ESD resection, 11,12,21,23,24 which are confirmed in our cohort. In this cohort, the results demonstrated large tumors were more likely to contain undifferentiated carcinoma components.…”

Section: Discussionsupporting

confidence: 87%

“…20 Although there have been some studies focused on the relationship between tumor size, location and, ulcer and NCR, few studies explored other pre-procedural endoscopic findings for ESD treatment-related NCR in EGCs, not to mention eCura C1 and eCura C2 resections. 11 , 12 , 21 To minimize the risk of NCR and related unnecessary additional resection procedures, it is critically important for endoscopists to thoroughly evaluate the risk for NCR before any ESD procedure. The aim of this study was to identify clinically useful risk factors that may predict the risk of NCR, especially of eCura C1 and eCura C2 resections, before the start of an ESD procedure in EGC patients.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection

Wang

Dang

et al. 2020

CMAR

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Non-curative resection (NCR) remains problematic in some cases of early gastric carcinomas (EGCs) treated by endoscopic submucosal dissection (ESD). The aim of this study was to identify predictors of NCR, especially of eCura C1 and eCura C2 resections, before ESD and study long-term outcomes of EGC patients with NCR. Patients and Methods: A retrospective review of medical records was conducted over an 8-year period for EGCs undergoing ESD. Clinicopathologic and endoscopic characteristics and patients' survival were analyzed. Risk factors for NCR and eCura C1 and C2 resections were assessed by logistic analyses. Survival of patients was estimated with the Kaplan-Meier method with a Log rank test. Results: A total of 463 patients with 472 lesions were qualified. By univariate and multivariate analyses, the predictors for NCR and eCura C2 resections were tumor size >20 mm, tumors located in cardia-fundus, uneven surface, margin elevation, and mixed and undifferentiated types, and those for eCura C1 resection were tumors located in cardia-fundus, negative lifting sign, and mixed and undifferentiated types. The 5-year cancer-specific and cancer-free survival rates were 100.0% and 94.2%, and 95.3% and 83.4% in the curative resection (CR) and NCR groups, respectively. The 5-year cancer-specific and cancer-free survival rates were significantly greater in the CR group than that in the NCR group (P <0.0001). Conclusion: In this cohort, we identified various endoscopic and pathologic features of EGCs to predict NCR, especially eCura C1 and eCura C2 resections before ESD. These clinically valuable factors would be very informative to endoscopists and surgeons who perform ESD to resect EGCs.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection

Wang

Dang

et al. 2020

CMAR

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“…Suzuki et al drew the conclusion through their research that positive margins with submucosal infiltration (odds ratio 3.6) and lymphovascular invasion (odds ratio 3.5) had significant correlation with lymph node metastasis and patients who didn't meet curative resection especially with lymphovascular invasion or positive margin with submucosal invasion should receive additional gastrectomy [31]. Positive lateral margin was related closely to a mixed-type carcinoma, larger than 3 cm in size and the upper one third of stomach, reported by Fu et al [32]. However, there is no research about the risk factor of vertical and lateral incomplete resection in EGCC patients which needs to study in depth.…”

Section: Discussionmentioning

confidence: 83%

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Fan

Sun

Cao

et al. 2020

Preprint

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Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% ( P =0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively ( P <0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% ( P <0.001). The distant metastasis rate was 0.4%, 0% and 2.3% ( P =0.150). The five-year disease-specific survival rate in the BEI group was 96.6% ( P =0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

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“…Another Japanese study reported that the risk factors of positive horizontal margin were tumor size of >3 cm (odds ratio [OR], 1.794; p =0.029), tumor located in the upper third of the stomach (OR, 3.382; p =0.015), and mixed histological type (OR, 2.347; p =0.002) [23]. In a Korean study of 1358 ESD-treated patients with EGCa that aimed to identify the risk factors of positive horizontal margin, the authors concluded that extremely well-differentiated adenocarcinoma and multiple lateral margins were the only risk factors [24].…”

Section: Frequency and Risk Factors Of Positive Horizontal Marginmentioning

confidence: 99%

Is Radical Surgery Necessary for All Patients Diagnosed as Having Non-Curative Endoscopic Submucosal Dissection?

Lee

Park

2019

Clin Endosc

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If a lesion does not meet the expanded indication criteria for treatment with endoscopic therapy for early gastric cancer or has a positive resection margin, it is regarded as suitable for non-curative resection. Non-curative resection is closely related to the risk of local recurrence, lymph node metastasis, and poor prognosis. If the result is confirmed as non-curative resection, additional treatment should be considered depending on the risks of residual tumor, local recurrence, and lymph node metastasis. As lymphatic invasion is the most important risk factor of recurrence and poor prognosis, surgical treatment should be considered if lymphatic invasion is present. If patients are not suitable for additional surgery owing to old age or coexisting severe disease, close surveillance can be an alternative treatment option.

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Relevant risk factors for positive lateral margin after en bloc endoscopic submucosal dissection for early gastric adenocarcinoma

Abstract: Positive LM is closely related to the upper third of stomach, a tumor larger than 3 cm and a mixed-type carcinoma. Additionally, positive LM has a predilection for recurrent or residual tumors.

Cited by 13 publications

References 20 publications

<p>Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection</p>

<p>Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection</p>

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Is Radical Surgery Necessary for All Patients Diagnosed as Having Non-Curative Endoscopic Submucosal Dissection?

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