scholarly journals Neutrophil Infiltration and the Distribution of Intestinal Metaplasia Is Associated with Metachronous Gastric Cancer following Endoscopic Submucosal Dissection

2015 ◽  
Vol 29 (6) ◽  
pp. 321-325 ◽  
Author(s):  
Takafumi Sugimoto ◽  
Yutaka Yamaji ◽  
Kosuke Sakitani ◽  
Yoshihiro Isomura ◽  
Shuntaro Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Intestinal Metaplasia ◽  
Neutrophil Infiltration ◽  
Rank Test ◽  
Gastric Cancers ◽  
Submucosal Dissection ◽  
Metachronous Gastric Cancer

BACKGROUND: Endoscopic submucosal dissection (ESD) of early gastric cancer is a minimally invasive procedure. However, the risk for metachronous cancers after successful cancer treatment remains high and the risk factors for metachronous cancers have not been elucidated.OBJECTIVE: To evaluate the risk factors for metachronous gastric cancers after ESD with a long-term follow-up.METHODS: A total of 155 consecutive patients (119 men, 36 women, mean age 68.9 years) were treated with ESD between September 2000 and September 2009. Biopsy specimens were obtained from the greater curvature of the antrum and middle corpus to evaluate gastric mucosal status, includingHelicobacter pylori, intestinal metaplasia (IM) and neutrophil infiltration (NI) before ESD. Follow-up endoscopy after ESD was scheduled at two and six months, one year and annually thereafter.H pylorieradication was recommended when possible.RESULTS: The median follow-up period was 4.2 years. Metachronous gastric cancers were found in 23 of 155 patients (3.5% per year). No local recurrences were observed. The cumulative incidence of metachronous gastric cancer was significantly high in IM and NI in the corpus (P=0.0093 and P=0.0025, respectively [log-rank test]). The ORs for IM and NI in the corpus were 2.65 and 3.06, respectively, according to the Cox proportional hazards model (P=0.024 and P=0.0091, respectively).CONCLUSIONS: The presence of IM and NI in the corpus was closely related to the development of metachronous gastric cancer after ESD.

Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 87-87
Author(s):  
Jae J. Kim
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Cancer Progression ◽  
Surveillance Period ◽  
Surveillance Strategy ◽  
Gastric Cancers ◽  
Submucosal Dissection ◽  
Cumulative Incidence Curve

87 Background: To suggest an appropriate surveillance strategy after curative endoscopic submucosal dissection (ESD) for early gastric cancers, based on incidence and patterns of local, metachronous, and extragastric recurrence. Methods: Between 2003 and 2011, 1497 consecutive patients with 1539 differentiated-type early gastric cancers meeting absolute or expanded indication criteria underwent curative ESD. They were followed up with esophagogastroduodenoscopy (EGD) and abdominal computed tomography (CT) under a standardized surveillance protocol. Long-term outcomes were analyzed for 1306 patients with at least 1 year’s follow-up. Results: Incidences of residual and synchronous lesions detected within 1 year were 0.13 % and 0.87 %, respectively. During median 47 months of follow-up, there was 1 local recurrence (0.08 %; early gastric cancer) and 47 cases of metachronous recurrence (3.6 %; 44 early gastric cancers, 3 pT2 advanced gastric cancers); all were curatively treated. During a 5-year surveillance, the cumulative incidence curve of metachronous recurrence increased linearly. Median time from ESD to metachronous recurrence was 30 months. There were 2 extragastric recurrences (0.15 %) in lymph nodes, at 5 and 4 years, respectively, after curative ESD for absolute and expanded indications. The patient with the expanded indications underwent a palliative operation and died of gastric cancer progression. Conclusions: There was a constant incidence rate of metachronous recurrence during a 5-year surveillance period and there was extragastric recurrence at least 4 years after ESD of early gastric cancer even for absolute indications. Therefore, annual or biannual surveillance EGD and abdominal CT might be necessary for at least 5 years after curative ESD for early gastric cancers, with absolute as well as expanded indications.

scholarly journals Risk Factors for Metachronous Recurrence after Endoscopic Submucosal Dissection of Early Gastric Cancer

2017 ◽  
Vol 32 (3) ◽  
pp. 421 ◽  
Author(s):  
Chang-Su Chung ◽  
Hyun Sun Woo ◽  
Jun-Won Chung ◽  
Seok Hoo Jeong ◽  
Kwang An Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection

scholarly journals Tu1514 ANALYSIS OF METACHRONOUS GASTRIC CANCER AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANER

2020 ◽  
Vol 91 (6) ◽  
pp. AB599
Author(s):  
Hidehiko Takabayashi ◽  
Tomoki Michida ◽  
Narumi Shuto ◽  
Yuji Terai ◽  
Saburo Matsubara ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection ◽  
Metachronous Gastric Cancer ◽  
Gastric Caner

Risk of recurrence when cutting into intramucosal (pT1a) cancer from the cutting-plane side during gastric endoscopic submucosal dissection

Endoscopy ◽  
2020 ◽  
Vol 52 (10) ◽  
pp. 833-838
Author(s):  
Hiroko Nakahira ◽  
Takashi Kanesaka ◽  
Noriya Uedo ◽  
Masayasu Ohmori ◽  
Hiroyoshi Iwagami ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Endoscopic Submucosal Dissection ◽  
Cutting Plane ◽  
Risk Of Recurrence ◽  
Gastric Cancers ◽  
Submucosal Dissection ◽  
Additional Surgery ◽  
Risk Factors For Recurrence ◽  
Surveillance Endoscopy

Background During endoscopic submucosal dissection (ESD), procedural difficulty and poor visibility of the cutting plane sometimes cause the operator to cut into the lesion from the cutting-plane side, making the vertical margin positive (VM1) or unclear (VMX). In the present study, we evaluated the risk of recurrence of gastric cancer with VM1 /VMX after ESD. Methods In total, 1723 consecutive gastric cancers treated by ESD at Osaka International Cancer Institute from July 2012 to December 2017 were included in this retrospective cohort study. Among them, 231 submucosal or more deeply invasive gastric cancers were excluded because nontechnical factors may contribute to VM1 /VMX in such lesions. To quantify the risk of cutting into cancer from the cutting-plane side during ESD, the proportion of lesions with VM1 /VMX among the pT1a gastric cancers treated by ESD was calculated. The proportion of recurrence among these cases was calculated after exclusion of lesions with positive lymphovascular invasion or a positive horizontal margin in order to eliminate the obvious risk factors for recurrence. Results Among 1492 pT1a gastric cancers treated by ESD, 28 lesions (1.9 %; 95 % confidence interval [CI] 1.3 % – 2.7 %) histologically showed VM1 /VMX. No local recurrence (0.0 %; 95 %CI 0.0 % – 12.2 %) occurred among 23 cases. The median follow-up period was 41 months (range 10 – 84 months). Conclusions No local recurrence was detected in pT1a gastric cancers after VM1 /VMX resection by ESD. Surveillance endoscopy could be adopted for such cases without additional surgery.

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