Evaluation of additional gastrectomy after noncurative endoscopic submucosal dissection for early gastric cancer
Abstract BackgroundPerforming additional surgery after noncurative endoscopic submucosal dissection (ESD) for early gastric cancer is controversial. Our aims are to clarify the risk factors for lymph node metastasis (LNM) and local residual cancer (RC) after noncurative ESD and to determine recommendations for additional treatment. MethodsOf the 1483 patients who underwent ESD for early gastric cancer between January 2012 and April 2020, we retrospectively analyzed 151 patients diagnosed as having a lesion not meeting the curative criteria after ESD. Of these patients, 100 underwent additional gastrectomy, and 51 were observed without surgery. ResultsSurgical specimens showed LNM in 14 patients (14.0 %) and local RC in 7 (7.0 %). However, 81 patients (81.0 %) had neither of these malignancies. Multivariate analysis revealed that a positive lymphatic invasion (P = 0.035) and an undifferentiated type (P = 0.047) were independent risk factors for LNM, whereas a positive horizontal margin (P = 0.017) was an independent risk factor for local RC. In the additional gastrectomy group, 3 patients (3.0 %) had recurrences, and 2 (2.0 %) died of gastric cancer. In the observation group, 1 patient (2.0 %) had distant recurrence, and 2 patients (3.9 %) had local recurrences.ConclusionFollowing noncurative ESD for early gastric cancer, we recommend an additional gastrectomy with lymph node dissection for patients with lymphovascular invasion and/or undifferentiated type. Careful follow-ups without additional surgery may be acceptable for patients with advanced age, severe comorbidity, or no lymphovascular invasion..
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Preprint| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
ResearchSquare.com - (2022) vom: 01. Apr. Zur Gesamtaufnahme - year:2022 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Makimoto, Shinichiro [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| doi: |
10.21203/rs.3.rs-1454886/v1 |
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| PPN (Katalog-ID): |
XRA035653779 |
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| 520 | |a Abstract BackgroundPerforming additional surgery after noncurative endoscopic submucosal dissection (ESD) for early gastric cancer is controversial. Our aims are to clarify the risk factors for lymph node metastasis (LNM) and local residual cancer (RC) after noncurative ESD and to determine recommendations for additional treatment. MethodsOf the 1483 patients who underwent ESD for early gastric cancer between January 2012 and April 2020, we retrospectively analyzed 151 patients diagnosed as having a lesion not meeting the curative criteria after ESD. Of these patients, 100 underwent additional gastrectomy, and 51 were observed without surgery. ResultsSurgical specimens showed LNM in 14 patients (14.0 %) and local RC in 7 (7.0 %). However, 81 patients (81.0 %) had neither of these malignancies. Multivariate analysis revealed that a positive lymphatic invasion (P = 0.035) and an undifferentiated type (P = 0.047) were independent risk factors for LNM, whereas a positive horizontal margin (P = 0.017) was an independent risk factor for local RC. In the additional gastrectomy group, 3 patients (3.0 %) had recurrences, and 2 (2.0 %) died of gastric cancer. In the observation group, 1 patient (2.0 %) had distant recurrence, and 2 patients (3.9 %) had local recurrences.ConclusionFollowing noncurative ESD for early gastric cancer, we recommend an additional gastrectomy with lymph node dissection for patients with lymphovascular invasion and/or undifferentiated type. Careful follow-ups without additional surgery may be acceptable for patients with advanced age, severe comorbidity, or no lymphovascular invasion. | ||
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| 700 | 1 | |a Takami, Tomoya |e verfasserin |4 aut | |
| 700 | 1 | |a Shintani, Hiroshi |e verfasserin |4 aut | |
| 700 | 1 | |a Kataoka, Naoki |e verfasserin |4 aut | |
| 700 | 1 | |a Yamaguchi, Tomoyuki |e verfasserin |4 aut | |
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