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Surgical Endoscopy

, Volume 33, Issue 12, pp 4078–4088 | Cite as

Long-term outcomes after non-curative endoscopic submucosal dissection for early gastric cancer according to hospital volumes in Japan: a multicenter propensity-matched analysis

  • Osamu Dohi
  • Waku HattaEmail author
  • Takuji Gotoda
  • Yuji Naito
  • Tsuneo Oyama
  • Noboru Kawata
  • Akiko Takahashi
  • Shiro Oka
  • Shu Hoteya
  • Masahiro Nakagawa
  • Masaaki Hirano
  • Mitsuru Esaki
  • Mitsuru Matsuda
  • Ken Ohnita
  • Ryo Shimoda
  • Motoyuki Yoshida
  • Jun Takada
  • Keiko Tanaka
  • Shinya Yamada
  • Tsuyotoshi Tsuji
  • Hirotaka Ito
  • Hiroyuki Aoyagi
  • Tooru Shimosegawa
Article

Abstract

Background

There is a lack of data regarding the long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) without curative resection, and the relationship of these outcomes with hospital volumes remains unclear. This study evaluated long-term outcomes of patients who underwent ESD for EGC without curative resection according to hospital volumes in Japan.

Methods

This multicenter retrospective study evaluated 1,969 patients who did not meet the criteria of the Japanese Gastric Cancer Association for curative resection between January 2000 and August 2011. Hospitals were classified according to the annual number of ESD procedures: low- and medium-volume group (LMVG), high-volume group (HVG), and very high-volume group (VHVG). Clinicopathological features, overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were compared across groups after a generalized propensity score matching analysis.

Results

In 495 pairs of generalized propensity score-matched patients, the 5-year OS, DSS, and RFS rates were 81.5%, 97.9%, and 97.6% for LMVG; 86.9%, 98.2%, and 97.0% for HVG; and 85.4%, 98.5%, and 97.6% for VHVG, respectively. The 5-year DSS and RFS rates did not significantly differ among the three groups. However, 5-year OS was significantly worse in the LMVG than in the HVG and VHVG (P < 0.001 and P = 0.008, respectively).

Conclusions

DSS and RFS in patients with EGC who did not meet the criteria for curative resection did not differ across hospital volumes in Japan. Even in cases in which ESD for EGC involved non-curative resection, the procedure is feasible across Japanese hospitals with different volumes.

Keywords

Hospital volume Long-term outcome Endoscopic submucosal dissection Early gastric cancer Propensity score matching 

Notes

Acknowledgements

We thank all members of the EAST Study Group. We also thank Naoto Iwai (Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan) and Hajime Yamakage (Satista Co., Ltd.), who assisted with statistical analysis.

Compliance with ethical standards

Disclosure

Osamu Dohi, Waku Hatta, Takuji Gotoda, Yuji Naito, Tsuneo Oyama, Noboru Kawata, Akiko Takahashi, Shiro Oka, Shu Hoteya, Masahiro Nakagawa, Masaaki Hirano, Mitsuru Esaki, Mitsuru Matsuda, Ken Ohnita, Ryo Shimoda, Motoyuki Yoshida, Jun Takada, Keiko Tanaka, Shinya Yamada, Tsuyotoshi Tsuji, Hirotaka Ito, Hiroyuki Aoyagi, and Tooru Shimosegawa have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Osamu Dohi
    • 1
  • Waku Hatta
    • 2
    Email author
  • Takuji Gotoda
    • 3
  • Yuji Naito
    • 1
  • Tsuneo Oyama
    • 4
  • Noboru Kawata
    • 5
  • Akiko Takahashi
    • 4
  • Shiro Oka
    • 6
  • Shu Hoteya
    • 7
  • Masahiro Nakagawa
    • 8
  • Masaaki Hirano
    • 9
  • Mitsuru Esaki
    • 3
    • 10
  • Mitsuru Matsuda
    • 11
  • Ken Ohnita
    • 12
  • Ryo Shimoda
    • 13
  • Motoyuki Yoshida
    • 14
  • Jun Takada
    • 15
  • Keiko Tanaka
    • 16
  • Shinya Yamada
    • 17
  • Tsuyotoshi Tsuji
    • 18
  • Hirotaka Ito
    • 19
  • Hiroyuki Aoyagi
    • 20
  • Tooru Shimosegawa
    • 2
  1. 1.Department of Gastroenterology and HepatologyKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of Gastroenterology, Graduate School of MedicineTohoku UniversitySendaiJapan
  3. 3.Division of Gastroenterology and Hepatology, Department of MedicineNihon University School of MedicineTokyoJapan
  4. 4.Division of EndoscopySaku Central Hospital Advanced Care CenterNaganoJapan
  5. 5.Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
  6. 6.Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
  7. 7.Department of GastroenterologyToranomon HospitalTokyoJapan
  8. 8.Department of EndoscopyHiroshima City HospitalHiroshimaJapan
  9. 9.Department of Internal MedicineNiigata Prefectural Central HospitalJoetsuJapan
  10. 10.Department of GastroenterologyKitakyushu Municipal Medical CenterKitakyushuJapan
  11. 11.Department of Internal MedicineToyama Prefectural Central HospitalToyamaJapan
  12. 12.Department of Gastroenterology and HepatologyNagasaki University HospitalNagasakiJapan
  13. 13.Department of Internal Medicine and Gastrointestinal EndoscopySaga Medical SchoolSagaJapan
  14. 14.Department of Gastroenterology and Endocrinology and MetabolismNara Medical UniversityNaraJapan
  15. 15.Department of GastroenterologyGifu University Graduate School of MedicineGifuJapan
  16. 16.Department of GastroenterologyShinshu University School of MedicineMatsumotoJapan
  17. 17.Department of Gastroenterology and HepatologyJapanese Red Cross Society Kyoto Daiichi HospitalKyotoJapan
  18. 18.Department of GastroenterologyAkita City HospitalAkitaJapan
  19. 19.Department of GastroenterologyOsaki Citizen HospitalOsakiJapan
  20. 20.Department of GastroenterologyFukui Prefectural HospitalFukuiJapan

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