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Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3636–3643 | Cite as

Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer?

  • Waku Hatta
  • Takuji GotodaEmail author
  • Tsuneo Oyama
  • Noboru Kawata
  • Akiko Takahashi
  • Shiro Oka
  • Shu Hoteya
  • Masahiro Nakagawa
  • Masaaki Hirano
  • Mitsuru Esaki
  • Mitsuru Matsuda
  • Ken Ohnita
  • Ryo Shimoda
  • Motoyuki Yoshida
  • Osamu Dohi
  • Jun Takada
  • Keiko Tanaka
  • Shinya Yamada
  • Tsuyotoshi Tsuji
  • Hirotaka Ito
  • Hiroyuki Aoyagi
  • Tomohiro Nakamura
  • Naoki Nakaya
  • Tooru Shimosegawa
  • Atsushi Masamune
Gastrointestinal Oncology
  • 129 Downloads

Abstract

Background

When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis (LNM).

Objective

This study aimed to identify high-risk patients for recurrence after additional surgery for curability C-2 ESD of EGC.

Methods

This multicenter retrospective cohort study enrolled 1064 patients who underwent additional surgery after curability C-2 ESD for EGC. We evaluated the recurrence rate and the risk factors for recurrence after additional surgery in these patients.

Results

The 5-year recurrence rate after additional surgery was 1.3%. Multivariate Cox analysis revealed that the independent risk factors for recurrence after additional surgery were LNM (hazard ratio [HR] 32.47; p < 0.001) and vascular invasion (HR 4.75; p = 0.014). Moreover, patients with both LNM and vascular invasion had a high rate of recurrence after additional surgery (24.6% in 5 years), with a high HR (119.32) compared with those with neither LNM nor vascular invasion. Among patients with no vascular invasion, a high rate of recurrence was observed in those with N2/N3 disease according to the American Joint Committee on Cancer TNM staging system (27.3% in 5 years), in contrast with no recurrence in those with N1 disease.

Conclusions

Patients with both LNM (N1–N3) and vascular invasion, as well as those with N2/N3 disease but no vascular invasion, would be candidates for adjuvant chemotherapy after additional surgery for curability C-2 ESD of EGC.

Notes

Acknowledgment

The authors thank Hiroyuki Ono (Shizuoka Cancer Center), Koki Nakamura (Hiroshima City Hospital), Naohiko Harada (National Hospital Organization Kyushu Medical Center), Yasumasa Hara (Toyama Prefectural Central Hospital), and Kohei Yamanouchi (Saga Medical School) for the enrollment of patients and data collection.

Disclosures

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

Supplementary material

10434_2019_7579_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 kb)
10434_2019_7579_MOESM2_ESM.docx (41 kb)
Supplementary material 2 (DOCX 41 kb)
10434_2019_7579_MOESM3_ESM.docx (228 kb)
Supplementary material 3 (DOCX 228 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Waku Hatta
    • 1
  • Takuji Gotoda
    • 2
    Email author
  • Tsuneo Oyama
    • 3
  • Noboru Kawata
    • 4
  • Akiko Takahashi
    • 3
  • Shiro Oka
    • 5
  • Shu Hoteya
    • 6
  • Masahiro Nakagawa
    • 7
  • Masaaki Hirano
    • 8
  • Mitsuru Esaki
    • 2
    • 9
  • Mitsuru Matsuda
    • 10
  • Ken Ohnita
    • 11
  • Ryo Shimoda
    • 12
  • Motoyuki Yoshida
    • 13
  • Osamu Dohi
    • 14
  • Jun Takada
    • 15
  • Keiko Tanaka
    • 16
  • Shinya Yamada
    • 17
  • Tsuyotoshi Tsuji
    • 18
  • Hirotaka Ito
    • 19
  • Hiroyuki Aoyagi
    • 20
  • Tomohiro Nakamura
    • 21
  • Naoki Nakaya
    • 21
  • Tooru Shimosegawa
    • 1
  • Atsushi Masamune
    • 1
  1. 1.Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Division of Gastroenterology and Hepatology, Department of MedicineNihon University School of MedicineTokyoJapan
  3. 3.Division of EndoscopySaku Central Hospital Advanced Care CenterSakuJapan
  4. 4.Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
  5. 5.Department of Gastroenterology and Metabolism, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  6. 6.Department of GastroenterologyToranomon HospitalTokyoJapan
  7. 7.Department of EndoscopyHiroshima City HospitalHiroshimaJapan
  8. 8.Department of Internal MedicineNiigata Prefectural Central HospitalJoetsuJapan
  9. 9.Department of GastroenterologyKitakyushu Municipal Medical CenterKitakyushuJapan
  10. 10.Department of Internal MedicineToyama Prefectural Central HospitalToyamaJapan
  11. 11.Department of Gastroenterology and HepatologyNagasaki University HospitalNagasakiJapan
  12. 12.Department of Internal Medicine and Gastrointestinal EndoscopySaga Medical SchoolSagaJapan
  13. 13.Department of Gastroenterology and Endocrinology and MetabolismNara Medical UniversityNaraJapan
  14. 14.Department of Gastroenterology and HepatologyKyoto Prefectural University of MedicineKyotoJapan
  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.Division of GastroenterologyFukui Prefectural HospitalFukuiJapan
  21. 21.Department of Preventive Medicine and EpidemiologyTohoku Medical Megabank OrganizationSendaiJapan

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