Preprocedural prediction of non-curative endoscopic submucosal dissection for early gastric cancer.

74 Background: Endoscopic submucosal dissection (ESD) has been accepted as the treatment of choice for early gastric cancer (EGC) without lymph node metastasis. However, additional surgical gastrectomy should be considered after non-curative endoscopic resection. We aimed to evaluate the predictive factors associated with non-curative endoscopic resection. Methods: Between November 2008 and June 2015, a retrospective study was conducted in a single, tertiary, referral hospital. A total of 596 EGC lesions resected by ESD were analyzed. Non-curative endoscopic resection was defined as the occurrence of lesions associated with piecemeal resection, positive resection margins, lymphovascular invasion, or lesions that did not meet the expanded indications for ESD. Results: The rate of non-curative endoscopic resection was 16.1%. The mean follow-up period was 35.3 ± 25.0 months. Associated predictive factors for non-curative endoscopic resection were female sex (OR, 2.470; p = 0.004), lesion size ≥ 20 mm (OR 3.714; p < 0.001), longer procedure time (OR 2.449, p = 0.002), ulceration (OR 3.538, p = 0.002), nodularity (OR 2.967, p < 0.001), depression (OR 1.806, p = 0.038), undifferentiated carcinoma (OR 2.825, p = 0.031) and lesion located in the mid or upper third of stomach (OR 7.135 and OR 4.155, p < 0.001, respectively). As the number of risk factors increased, the risk of non-curative ESD also increased. Conclusions: Prior to selection of ESD, the risks associated with non-curative ESD should be considered so that appropriate treatment modalities may be selected.

Download Full-text

Local Recurrence After Endoscopic Submucosal Dissection of Early Gastric Cancer

10.21203/rs.3.rs-1147125/v1 ◽

2022 ◽

Author(s):

Cheol Woong Choi ◽

Su Jin Kim ◽

Dae Gon Ryu ◽

Dae Hwan Kang ◽

Hyung Wook Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Local Recurrence ◽

Endoscopic Submucosal Dissection ◽

Lesion Size ◽

Tertiary Referral Hospital ◽

En Bloc ◽

Factors Associated ◽

Submucosal Dissection ◽

Undifferentiated Adenocarcinoma

Abstract Background: Endoscopic submucosal dissection (ESD) is considered the treatment of choice for early gastric cancer (EGC) with a negligible risk of lymph node metastasis. However, locally recurrent lesions on artificial ulcer scars are difficult to manage. Therefore, predicting the risk of local recurrence after ESD is important to manage and prevent the event. This study aimed to elucidate risk factors associated with local recurrence after ESD of EGC.Methods: Between November 2008 and February 2016, consecutive patients (n=641; mean age, 69.3±9.5 years; men, 77.2%) with EGC who underwent ESD at a single tertiary referral hospital were retrospectively analyzed to evaluate the incidence and factors associated with local recurrence. Local recurrence was defined as the development of neoplastic lesions at or adjacent to the site of the post-ESD scar.Results: En bloc and complete resection rates were 97.8% and 93.6%, respectively. The local recurrence rate after ESD was 3.1%. The mean follow-up period after ESD was 50.7±32.5 months. One case of gastric cancer-related death (0.15%) was noted, wherein the patient had refused additive surgical resection after ESD for EGC with lymphatic and deep submucosal invasion. Lesion size ≥15 mm, incomplete histologic resection, undifferentiated adenocarcinoma, scar, and absence of erythema of the surface were associated with a higher risk of local recurrence. Conclusions: Predicting local recurrence during regular endoscopic surveillance after ESD is important, especially in patients with a larger lesion size (≥15 mm), incomplete histologic resection, surface changes of scars, and no erythema of the surface.

Download Full-text

Tu1691 Endoscopic Submucosal Dissection as a Treatment for Gastric Adenomatous Polyps: Predictive Factors for Early Gastric Cancer

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2012.03.1337 ◽

2012 ◽

Vol 75 (4) ◽

pp. AB490 ◽

Cited By ~ 1

Author(s):

Jong Kun Ha ◽

Cheol Woong Choi ◽

Hyung Wook Kim ◽

Dae Hwan Kang ◽

Su Bum Park ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Predictive Factors ◽

Adenomatous Polyps ◽

Submucosal Dissection

Download Full-text

Predictive Factors of Beyond Expanded Indication of Endoscopic Submucosal Dissection in Early Gastric Cancer

Gastroenterology ◽

10.1016/s0016-5085(17)31163-0 ◽

2017 ◽

Vol 152 (5) ◽

pp. S258-S259

Author(s):

Dae Gon Ryu ◽

Cheol Woong Choi ◽

Dae Hwan Kang ◽

Hyung Wook Kim ◽

Su Bum Park ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Predictive Factors ◽

Submucosal Dissection

Download Full-text

Preoperative predictors of beyond endoscopic submucosal dissection indication or lymphovascular invasion in endoscopic resection for early gastric cancer

Surgical Endoscopy ◽

10.1007/s00464-017-6009-8 ◽

2017 ◽

Vol 32 (6) ◽

pp. 2948-2957 ◽

Cited By ~ 5

Author(s):

Su Jin Kim ◽

Cheol Woong Choi ◽

Dae Hwan Kang ◽

Hyung Wook Kim ◽

Su Bum Park ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Endoscopic Resection ◽

Lymphovascular Invasion ◽

Submucosal Dissection ◽

Preoperative Predictors

Download Full-text

Predictive Factors for Local Recurrence and Incomplete Resection of Early Gastric Cancer Treated by Endoscopic Resection: A Western Experience

Canadian Journal of Gastroenterology ◽

10.1155/2009/986495 ◽

2009 ◽

Vol 23 (5) ◽

pp. 357-363 ◽

Cited By ~ 3

Author(s):

Fábio Yuji Hondo ◽

Fauze Maluf-Filho ◽

Humberto Setsuo Kishi ◽

Ricardo Sato Uemura ◽

Luciano Okawa ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Local Recurrence ◽

Endoscopic Resection ◽

Predictive Factors ◽

Predictive Factor ◽

Lesion Size ◽

Complete Resection ◽

Incomplete Resection ◽

Resection Group

BACKGROUND: Early gastric cancer (EGC) is defined as adenocarcinoma limited to the mucosa or submucosa regardless of lymph node involvement. Local EGC recurrence rates have been described in up to 6% of cases.OBJECTIVES: To evaluate predictive factors for incomplete resection and local recurrence of EGC treated by endoscopic mucosal resection (EMR) that was followed up for at least one year.METHODS: From June 1994 to December 2005, 46 patients with EGC underwent EMR. Possible predictive factors for incomplete endoscopic resection and local recurrence were identified by medical chart analysis. Demographic, endoscopic and histopathological data were retrospectively evaluated. EMR was considered complete or incomplete. Patients from the complete resection group were divided into subgroups (with and without local EGC recurrence).RESULTS: Complete resection was possible in 36 cases (76.6%). Predictive factors for incomplete resection were tumour location (P=0.035), histological type (P=0.021), lesion size (P=0.022) and number of resected fragments (P=0.013). On multivariate analysis, undifferentiated histological type (OR 0.8; 95% CI 0.036 to 0.897) and number of resected fragments (OR 7.34; 95% CI 1.266 to 42.629) were independent predictive factors for incomplete resection. In the complete resection group, a larger lesion size was associated with a higher the number of resected fragments (P=0.018). Local recurrence occurred in nine cases (25%). Use of the cap technique was the only predictive factor for local recurrence in five of seven cases (71.4%) (P=0.006).CONCLUSIONS: A larger lesion size was associated with a higher number of resected fragments. Undifferentiated adenocarcinoma and piecemeal resection were predictive factors for incomplete resection. Technique type was a predictive factor for local EGC recurrence.

Download Full-text