Jae Pil Han1, Su Jin Hong2, Hee Kyung Kim3, Yun Nah Lee1, Tae Hee Lee1, Bong Min Ko1, Joo Young Cho1. 1. Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea. 2. Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea. sjhong@schmc.ac.kr. 3. Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea.
Abstract
BACKGROUND: Non-curative resection after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) can contribute to local recurrence or lymphatic and distant metastasis of the tumor. We stratified the risk of local recurrence according to the histological characteristics in non-curative resection after ESD for EGC. METHODS: Among 892 EGCs treated with ESD, 152 (17.0%) were classified as non-curative resection based on the histology after ESD. The clinical outcomes and risk factors associated with local recurrence were analyzed retrospectively in non-curative resections. RESULTS: Of 152 non-curative resections, 46 (30.3%) were stratified as Group 1 (incomplete resection and met the ESD criteria), 31 (20.4%) as Group 2 (complete resection and exceeded the ESD criteria), 41 (27.0%) as Group 3 (incomplete resection and exceeded the ESD criteria), and 34 (22.4%) as Group 4 (lymphovascular invasion regardless of complete resection). Group 3 [odds ratio (OR) 3.991; p = 0.015] and Group 4 (OR 4.487; p = 0.014) had higher rates of local recurrence after non-curative resection. In those high-risk groups, endoscopic surveillance without additional treatment detected significantly more local recurrence than in those receiving additional treatment (p = 0.029). CONCLUSION: Risk stratification for non-curative resection is important for EGC prognosis after ESD. Moreover, additional treatment for non-curative resection influences long-term outcomes, especially in high-risk groups.
BACKGROUND: Non-curative resection after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) can contribute to local recurrence or lymphatic and distant metastasis of the tumor. We stratified the risk of local recurrence according to the histological characteristics in non-curative resection after ESD for EGC. METHODS: Among 892 EGCs treated with ESD, 152 (17.0%) were classified as non-curative resection based on the histology after ESD. The clinical outcomes and risk factors associated with local recurrence were analyzed retrospectively in non-curative resections. RESULTS: Of 152 non-curative resections, 46 (30.3%) were stratified as Group 1 (incomplete resection and met the ESD criteria), 31 (20.4%) as Group 2 (complete resection and exceeded the ESD criteria), 41 (27.0%) as Group 3 (incomplete resection and exceeded the ESD criteria), and 34 (22.4%) as Group 4 (lymphovascular invasion regardless of complete resection). Group 3 [odds ratio (OR) 3.991; p = 0.015] and Group 4 (OR 4.487; p = 0.014) had higher rates of local recurrence after non-curative resection. In those high-risk groups, endoscopic surveillance without additional treatment detected significantly more local recurrence than in those receiving additional treatment (p = 0.029). CONCLUSION: Risk stratification for non-curative resection is important for EGC prognosis after ESD. Moreover, additional treatment for non-curative resection influences long-term outcomes, especially in high-risk groups.
Entities:
Keywords:
Early gastric cancer; Endoscopic submucosal dissection; Non-curative resection
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