Long-term outcomes of patients with early gastric cancer found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after endoscopic submucosal dissection
Gastric cancer treatment guidelines recommend additional surgery as the standard treatment for lesions for which endoscopic submucosal dissection (ESD) is not indicated. However, the incidence of lymph-node metastasis is low in most patients.
Methods and materials
The study comprised 231 patients (231 lesions) who underwent ESD for early gastric cancer (EGC) in our hospital from September 2002 through March 2015 and were found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after ESD. The patients were divided into the additional operation group and the follow-up group, and long-term outcomes were studied retrospectively. Risk factors for metastasis and recurrence were also studied (capture rate, 98.7%).
The median follow-up was 48 months. There were 174 men and 57 women with a median age of 72 years. The additional operation group comprised 118 patients, and the follow-up group comprised 113 patients. The rates of 5-year cause-specific survival and 5-year overall survival were significantly higher in the additional operation group (100 and 96.0%, respectively) than in the follow-up group (92.6 and 73.3%, respectively; p = 0.010, p < 0.001). In the follow-up group, 5 patients (4.4%) died of gastric cancer (p = 0.021). Among elderly patients 75 years or older, long-term outcomes did not differ significantly between the groups. Sixteen patients had metastasis or recurrence, and the presence of lymphatic involvement was an independent risk factor for metastasis, recurrence, or both (p = 0.003; odds ratio 10.594; 95% confidence interval 2.294–48.927).
In patients with EGC who are confirmed to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after ESD, additional surgery should be aggressively performed if the patient can tolerate such treatment. In elderly patients aged 75 years or older and patients with serious underlying diseases, follow-up observation was suggested to be one option in patients who give informed consent after receiving an explanation of the risk of recurrence.
KeywordsEarly gastric cancer Endoscopic submucosal dissection Lesions for which endoscopic treatment is not indicated
No research support was received for this study.
Compliance with ethical standards
Authors Takafumi Yano, Kenji Ishido, Satoshi Tanabe, Takuya Wada, Mizutomo Azuma, Natsuko Kawanishi, Sakiko Yamane, Akinori Watanabe, Chikatoshi Katada, and Wasaburo Koizumi have no conflicts of interest or financial ties to disclose.
Informed consent was obtained from all patients in accordance with our institutional protocol.
- 3.Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver.4) Gastric cancer 2016 (Published online)Google Scholar
- 8.Tanabe S, Ishido K, Matsumoto T, Kosaka T, Oda I, Suzuki H, Fujisaki J, Ono H, Kawata N, Oyama T, Takahashi A, Doyama H, Kobayashi M, Uedo N, Hamada K, Toyonaga T, Kawara F, Tanaka S, Yoshifuku Y (2017) Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: multicenter collaborative study. Gastric Cancer 20:45–52CrossRefPubMedGoogle Scholar
- 9.Ishii S, Yamashita K, Kato H, Nishizawa N, Ushiku H, Mieno H, Moriya H, Hosoda K, Katada N, Kikuchi S, Tanabe S, Koizumi W, Saegusa M, Watanabe M (2016) Predictive factors for lymph node metastasis in additional gastrectomy after endoscopic resection of cT1aN0 gastric cancer. Surg Today 46:1031–1038CrossRefPubMedGoogle Scholar
- 17.Fried L, Barron J (2005) Older adults. Handbook of urban health: populations, methods, and practice. Springer, New YorkGoogle Scholar
- 18.Sumiyoshi T, Kondo H, Fujii R, Minagawa T, Fujie S, Kimura T, Ihara H, Yoshizaki N, Hirayama M, Oyamada Y, Okushiba S (2017) Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older. Gastric Cancer 20:489–495CrossRefPubMedGoogle Scholar