scholarly journals Recurrence rate of intramucosal gastric cancer with positive vertical margin due to lesion damage during endoscopic submucosal dissection

2021 ◽  
Vol 84 (2) ◽  
pp. 289-294
Author(s):  
J Hayasaka ◽  
D Kikuchi ◽  
K Nomura ◽  
H Odagiri ◽  
Y Ochiai ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Confidence Interval ◽  
Endoscopic Submucosal Dissection ◽  
Recurrence Rate ◽  
Curative Resection ◽  
Recurrence Rates ◽  
Submucosal Dissection ◽  
Additional Surgery ◽  
Significant Difference ◽  
Margin Positive

Background and study aim: In principle, additional surgery is performed after endoscopic submucosal dissection for early gastric cancer if the vertical margin is positive, regardless of lesion damage. The recurrence rate of vertical margin-positive lesions due to lesion damage after endoscopic submucosal dissection is unknown, and unnecessary surgeries may be performed. In this study, we investigated whether there was a difference in the recurrence rate between vertical margin-positive lesions due to lesion damage and vertical margin-negative lesions. Patients and methods: We included 1,294 intramucosal gastric cancer lesions that were resected by endoscopic submucosal dissection between January 2008 and December 2016, without additional surgery. The lesions were divided into the Damage and No damage groups based on vertical margin status. The Damage group had only one non-curative indication: a positive vertical margin due to lesion damage. The No damage group had no non curative indications. We compared the recurrence rate between the Damage and No damage groups. Results: The recurrence rates of the Damage and No damage groups were 0% (0/23; 95% confidence interval: 0-14.8%) and 0% (0/1,271; 95% confidence interval: 0-0.003%), respectively, with no statistically significant difference. Conclusions: In intramucosal gastric cancer, the recurrence rate of vertical margin-positive lesions due to lesion damage was 0%, which did not differ from that of vertical margin-negative lesions with curative resection. Follow-up, instead of additional surgery, may be an option for patients with non-curative resection when the only non-curative indication is a positive vertical margin due to lesion damage.

Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases

Surgery Today ◽  
2016 ◽  
Vol 47 (2) ◽  
pp. 202-209 ◽  
Author(s):  
Hideki Sunagawa ◽  
Takahiro Kinoshita ◽  
Akio Kaito ◽  
Hidehito Shibasaki ◽  
Kazuhiro Kaneko ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Retrospective Analysis ◽  
Curative Resection ◽  
Submucosal Dissection ◽  
Additional Surgery

scholarly journals Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer

2015 ◽  
Vol 04 (01) ◽  
pp. E24-E29 ◽  
Author(s):  
Kohei Yamanouchi ◽  
Shinichi Ogata ◽  
Yasuhisa Sakata ◽  
Nanae Tsuruoka ◽  
Ryo Shimoda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection ◽  
Additional Surgery

scholarly journals Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5768
Author(s):  
Sejin Lee ◽  
Jeong Ho Song ◽  
Sung Hyun Park ◽  
Minah Cho ◽  
Yoo Min Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Treatment Guidelines ◽  
Risk Group ◽  
Venous Invasion ◽  
High Risk Group ◽  
Submucosal Dissection ◽  
Additional Surgery

Background: Additional surgery after non-curative endoscopic submucosal dissection (ESD) may be excessive as few patients have lymph node metastasis (LNM). It is necessary to develop a risk stratification system for LNM after non-curative ESD, such as the eCura system, which was introduced in the Japanese gastric cancer treatment guidelines. However, the eCura system requires venous and lymphatic invasion to be separately assessed, which is difficult to distinguish without special immunostaining. In this study, we practically modified the eCura system by classifying lymphatic and venous invasion as lymphovascular invasion (LVI). Method: We retrospectively reviewed 543 gastric cancer patients who underwent radical gastrectomy after non-curative ESD between 2006 and 2019. LNM was evaluated according to LVI as well as size >30 mm, submucosal invasion ≥500 µm, and vertical margin involvement, which were used in the eCura system. Results: LNM was present in 8.1% of patients; 3.6%, 2.3%, 7.4%, 18.3%, and 61.5% of patients with no, one, two, three, and four risk factors had LNM, respectively. The LNM rate in the patients with no risk factors (3.6%) was not significantly different from that in patients with one risk factor (2.3%, p = 0.523). Among patients with two risk factors, the LNM rate without LVI was significantly lower than with LVI (2.4% vs. 10.7%, p = 0.027). Among patients with three risk factors, the LNM rate without LVI was lower than with LVI (0% vs. 20.8%, p = 0.195), although not statistically significantly. Based on LNM rates according to risk factors, patients with LVI and other factors were assigned to the high-risk group (LNM, 17.4%) while other patients as a low-risk group (LNM, 2.4%). Conclusions: Modifying the eCura system by classifying lymphatic and venous invasion as LVI successfully stratified LNM risk after non-curative ESD. Moreover, the high-risk group can be simply identified based on LVI and the presence of other risk factors.

Long-term outcome of endoscopic submucosal dissection for early gastric cancer compared to surgical resection.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 120-120 ◽  
Author(s):  
Eun Hui Sim ◽  
Byung-Wook Kim ◽  
Ji Hee Kim ◽  
Jin-Jo Kim
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Early Gastric Cancer ◽  
Clinical Outcome ◽  
Endoscopic Submucosal Dissection ◽  
Surgical Resection ◽  
Resection Group ◽  
Submucosal Dissection ◽  
Significant Difference

120 Background: Endoscopic submucosal dissection (ESD) is now accepted as an alternative to surgery for the treatment of early gastric cancer (EGC). However, long-term clinical outcome of ESD for EGC compared to surgical resection has not been evaluated. The aim of this study is to evaluate the clinical outcome of ESD for EGC compared to surgical resection. Methods: A retrospective analysis was performed in 152 patients who underwent ESD or surgical resection for EGC according to Gotoda’s extended criteria from 2006 and 2008 in Incheon St. Mary’s Hospital and Seoul St. Mary’s Hospital, The Catholic University of Korea. Overall survival and recurrence rates were compared between the two groups. Results: A total of 56 patients underwent surgical gastrectomy and 96 patients underwent ESD. The medial follow-up was 76 months in surgical resection group and 71 months in ESD group. Metachronous recurrences including dysplasia were found in 9 patients in ESD group and none in surgical resection group (P=0.001). There was no significant difference between the groups in overall survival. Conclusions: Gotoda’s extended criteria for ESD might be acceptable for the treatment of EGC considering the oval survival. However, meticulous surveillance program should be established because metachronous recurrence is more common after ESD.

scholarly journals A suitable marking method to achieve lateral margin negative in endoscopic submucosal dissection for undifferentiated-type early gastric cancer

2019 ◽  
Vol 07 (02) ◽  
pp. E274-E281
Author(s):  
Shoichi Yoshimizu ◽  
Yorimasa Yamamoto ◽  
Yusuke Horiuchi ◽  
Toshiyuki Yoshio ◽  
Akiyoshi Ishiyama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
Narrow Band Imaging ◽  
Lateral Margin ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Undifferentiated Type

Abstract Background and study aims Delineating undifferentiated-type early gastric cancer (UD-type EGC) from noncancerous areas is difficult. Therefore, the lateral margin negative (LM−) resection rate of endoscopic submucosal dissection (ESD) is lower for UD-type EGC than for differentiated-type EGC. This study aimed to retrospectively evaluate the effectiveness of the marking methods with circumferential biopsies in ESD for UD-type EGC. Patients and methods We analyzed the clinical outcomes of ESD in 127 patients with UD-type EGC between April 2013 and 2017. We performed diagnostic delineation of cancerous areas using magnifying endoscopy with narrow-band imaging, and four or more circumferential biopsies approximately 5 mm apart from the estimated lesion border were obtained to confirm noncancerous areas. The markings were placed on the circumferential biopsy scars, and a mucosal incision line was made outside the markings. Results Median size of the tumors and ESD specimens was 12 and 35 mm, respectively. En-bloc resection rate was 100 % (127/127), and LM− and curative resection rates were 97.6 % (124/127) and 80.3 % (102/127), respectively. Circumferential biopsy in preoperative esophagogastroduodenoscopy has successfully identified the misdiagnosis of cancerous areas of four patients (3.2 %), with three (2.4%) achieving LM− resection. LM + resection was pathologically identified in three patients (2.4 %), with all undergoing non-curative resection due to > 20-mm tumor. The proportion of patients with the shortest distance ≥ 5 mm from the lesion edge to the specimen edge was 88.2 % (112/127). Conclusion Our marking methods with circumferential biopsies may reduce LM + resections in ESD for UD-type EGC.

scholarly journals Endoscopic submucosal dissection of malignant non-pedunculated colorectal lesions

2018 ◽  
Vol 06 (08) ◽  
pp. E961-E968 ◽  
Author(s):  
Carl-Fredrik Rönnow ◽  
Jacob Elebro ◽  
Ervin Toth ◽  
Henrik Thorlacius
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
Residual Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Additional Surgery ◽  
Procedural Time

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is an established method for en bloc resection of large non-pedunculated colorectal lesions in Asia but dissemination of ESD in Western countries is limited. The aim of this study was to evaluate the role of ESD in the management of malignant non-pedunculated colorectal lesions in a European center. Patients and methods Among 255 patients undergoing colorectal ESD between 2014 and 2016, 29 cases were identified as submucosal invasive cancers and included in this study. The main outcomes were en bloc, R0 and curative resection as well as procedural time, complications and recurrence. Results Median tumor size was 40 mm (range 20 – 70 mm). Thirteen cancers were located in the colon and 16 were located in the rectum. Procedural time was 89 minutes (range 18 – 594 minutes). Complete resection was achieved in 28 cases, en bloc and R0 resection rates were 83 % and 69 %, respectively. Curative resection rate was 38 %. One case had a perforation in the sigmoid colon requiring emergency surgery. No significant bleeding occurred. Six patients underwent additional surgery after ESD, one of whom had residual tumor. One recurrence was detected in 20 patients that were followed-up endoscopically, median follow-up time was 13 months (range 2 – 30 months). Conclusion ESD seems to be a safe and effective method for treating non-pedunculated malignant colorectal lesions after careful patient selection and proper endoscopic training.

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