scholarly journals Clinical significance of additional gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective single-center study

2021 ◽  
Vol 17 (2) ◽  
pp. 68-72
Author(s):  
Uicheon Jeong ◽  
Ho Yoon Bang ◽  
Pyeong Su Kim
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Univariate Analysis ◽  
Lymphatic Invasion ◽  
Residual Cancer ◽  
Clinicopathologic Characteristics ◽  
Submucosal Dissection ◽  
Additional Surgery ◽  
Single Center Study ◽  
Additional Gastrectomy ◽  
Significant Factors

Purpose: Additional surgery is recommended for patients after a non-curative endoscopic submucosal dissection (ESD) to prevent residual cancer (RC) or lymph node metastasis (LNM). We aimed to evaluate the clinicopathologic characteristics of patients who underwent an additional gastrectomy after a non-curative ESD procedure and identify the risk factors of RC and LNM.Methods: We retrospectively assessed the clinicopathological factors of 73 patients who underwent additional gastrectomy following a non-curative ESD between January 2009 and December 2019 at our center.Results: RC and LNM rates after additional gastrectomy were 9.6% and 8.2%, respectively. Invasion deeper than 500 μm (P = 0.045), positive horizontal resection margin (P < 0.001), and positive ESD margin (P = 0.001) were identified as statistically significant factors in univariate analysis for RC, but not in multivariate analysis. Lymphatic invasion was the only risk factor found to be significant in both univariate and multivariate analyses (P = 0.005 and P = 0.012).Conclusion: Additional gastrectomy is necessary to prevent RC or LNM after non-curative ESD. Lymphatic invasion was also associated with LNM in patients who underwent an additional gastrectomy after a non-curative ESD, and in such cases, active treatment is required.

255 OUTCOME OF ADDITIONAL ESOPHAGECTOMY AFTER NON-CURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION FOR C-MM-SM1ESOPHAGEAL CANCER.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
H Fujita ◽  
Y Minamiya ◽  
Y Nagaki ◽  
Y Sato ◽  
A Wakita ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Venous Invasion ◽  
Primary Treatment ◽  
Lymphatic Invasion ◽  
Additional Treatment ◽  
Submucosal Dissection ◽  
Gastric Tube Ulcer ◽  
Additional Surgery ◽  
Upper Abdomen

Abstract   For patients diagnosed cT1(MM-SM1)N0 esophageal cancer, we perform endoscopic submucosal dissection (ESD) as a primary treatment. Furthermore, additional treatments were performed for the patients diagnosed pT1b(SM) in resected tumor by ESD. Our aim of this study is to investigate whether additional esophagectomy after non-curative ESD can be considered a valid treatment. Methods Forty-four patients who received esophagectomy with lymph node (LN) dissection in neck, mediastinum and upper abdomen as additional surgery after non-curative ESD between 2006 and 2019 were enrolled. Histological examination revealed that squamous cell carcinoma in 41 and adenocarcinoma in 3 patients. We examined the rate of pathological LN metastasis and outcomes of patients received esophagectomy. Results The cT was LPM in 9(20%), MM-SM1 in 35 (80%) patients. However, the pT was MM in 3(7%), SM1 in 14 (32%) and SM2 in 27 (61%) patients. Lymphatic invasion was positive in 32 (73%) and venous invasion was positive in 16(36%) patients. Seven patients had pathological metastatic LN (1–2 LNs/case) (total 10 metastatic LNs). The metastatic LNs existed in neck, mediastinum and upper abdomen. The recurrences were occurred in 2 patients (No.106recL LN and No. 112ao-A LN). One patient died by esophageal cancer (LN recurrence, 38 months alive). One patient died of gastric tube ulcer perforation (16 months). Conclusion We showed that esophagectomy with extended LN dissection is sufficient as additional treatment for the patients treated non-curative ESD. To expand the indications of ESD for pSM esophageal cancer, new methods are needed, such as the risk diagnosis of LN metastasis using genetic analysis.

scholarly journals Risk Factors for Additional Surgery after Iatrogenic Perforations due to Endoscopic Submucosal Dissection

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Gi Jun Kim ◽  
Sung Min Park ◽  
Joon Sung Kim ◽  
Jeong Seon Ji ◽  
Byung Wook Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Endoscopic Submucosal Dissection ◽  
Univariate Analysis ◽  
Anterior Wall ◽  
Submucosal Dissection ◽  
Additional Surgery ◽  
Subepithelial Lesion ◽  
Epithelial Neoplasms ◽  
Subepithelial Tumors

Objectives. Endoscopic resection (ER) is commonly performed to treat gastric epithelial neoplasms and subepithelial tumors. The aim of this study was to predict the risk factors for surgery after ER-induced perforation. Methods. We retrospectively reviewed the data on patients who received gastric endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) between January 2010 and March 2015. Patients who were confirmed to have perforation were classified into surgery and nonsurgery groups. We aimed to determine the risk factors for surgery in patients who developed iatrogenic gastric perforations. Results. A total of 1183 patients underwent ER. Perforation occurred in 69 (5.8%) patients, and 9 patients (0.8%) required surgery to manage the perforation. In univariate analysis, anterior location of the lesion, a subepithelial lesion, two or more postprocedure pain killers within 24 hrs, and increased heart rate within 24 hrs after the procedure were the factors related to surgery. In logistic regression analysis, the location of the lesion at the anterior wall and using two or more postprocedure pain killers within 24 hrs were risk factors for surgery. Conclusion. Most cases of perforations after ER can be managed conservatively. When a patient requires two or more postprocedure pain killers within 24 hrs and the lesion is located on the anterior wall, early surgery should be considered instead of conservative management.

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.

The accuracy of endoscopic ultrasonography for identifying stomach neoplasm before endoscopic submucosal dissection.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 22-22
Author(s):  
Pil Hun Song ◽  
Hyun Sung ◽  
Jeonghun Lee ◽  
Won Jae Yoon ◽  
You Sun Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Retrospective Study ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Ultrasonography ◽  
Tumor Size ◽  
Stomach Neoplasm ◽  
Muscle Layer ◽  
Lymphatic Invasion ◽  
Submucosal Layer ◽  
Submucosal Dissection

22 Background: The treatment of stomach neoplasm was determined by the identification on of invasion extent and perigastric lymph node through endoscopic ultrasonography (EUS). In this study, we investigated diagnostic accuracy of EUS examination before endoscopic submucosal dissection (ESD). Methods: A retrospective study was conducted to both EUS and ESD for stomach neoplasms that were performed at Seoul Paik Hospital between January 2006 and July 2015. We compared the accuracy of EUS according to the location of lesion, tumor size and ulcer presence or absence on lesion. Results: 49 patients were enrolled in this study; their mean age was 64.14 ± 11.33 years. There were 40 male (81.6%) and 9 female (18.4%) patients. The cases of confined to the mucosa on pathology finding were 41 (83.6%) and involved to submucosal layer(sm) 1 were 3 (6.1%) and sm2 were 2 (4%) and sm3 were 1 (2%) and proper muscle layer were 2 (4%). The cases of lymphatic invasion were 2 (4%). The sensitivity and accuracy of antrum were 91.6 % (95% CI: 0.81-1.03) and 83.3 % (95% CI: 0.70-0.97), body of stomach were 92.3 % (CI: 0.78-1.07) and 83.3% (CI: 0.66-1.00), respectively. Whether lesions were no significant differences in any location. The tumor size was divided by smaller than 20 mm group, 20-30 mm group and more than 30 mm group. The smaller than 20 mm group, 20-30 mm group and more than 30 mm group were 36, 9, 2 patients. The remaining 2 patients were not described. The sensitivity and accuracy of smaller than 20 mm group were 96.6 % (95% CI: 0.90-1.03) and 83.3 % (CI: 0.71-0.95) and 2-30 mm group were 66.7 % (CI: 0.29-1.04) and 77.8 % (CI: 0.51-1.04), respectively. All patients were divided by ulcer presence or not. 27 patients were ulcer presence and 22 patients were not. The sensitivity and accuracy of ulcer presence group were 77.3 % (CI : 0.60-0.95) and 74 % (CI : 0.57-0.90), ulcer absence group were 95 % (CI : 0.85-1.04) and 91 % (CI : 0.79-1.02). Conclusions: The EUS for stomach neoplasm was reliable of lesion without ulcerous finding, smaller than 20 mm in diameter and irrespective of stomach neoplasm location.

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