Satoshi Tanabe1, Kenji Ishido2, Takayuki Matsumoto3, Takashi Kosaka3, Ichiro Oda4, Haruhisa Suzuki4, Junko Fujisaki5, Hiroyuki Ono6, Noboru Kawata6, Tsuneo Oyama7, Akiko Takahashi7, Hisashi Doyama8, Masaaki Kobayashi9, Noriya Uedo10, Kenta Hamada10, Takashi Toyonaga11, Fumiaki Kawara11, Shinji Tanaka12, Yoshikazu Yoshifuku12. 1. Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan. s-tanabe@kitasato-u.ac.jp. 2. Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan. 3. Department of Gastroenterology, Iwate Medical University, Morioka, Japan. 4. Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan. 5. Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo, Japan. 6. Department of Endoscopy, Shizuoka Prefectural Cancer Center, Nagaizumi, Japan. 7. Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan. 8. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan. 9. Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan. 10. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. 11. Division of Gastroenterology, Kobe University Graduate School of Medicine, Kusunoki, Japan. 12. Department of Endoscopic Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Abstract
OBJECTIVE: The indications for endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC) have been expanded. However, the long-term outcomes of ESD remain unclear. We retrospectively investigated the long-term outcomes of ESD in patients with EGC. METHODS: We retrospectively studied patients with EGC who underwent ESD at 11 institutions between January 2003 and December 2010. A total of 6456 patients (7979 lesions) who met the absolute indications for ESD and 4202 patients (5781 lesions) who met the expanded indications for ESD were studied. Clinicopathological features, clinical course, and outcomes were studied in 67 patients in whom local recurrence or metastatic recurrence was diagnosed as of March 31, 2014. The median follow-up period was 56 months. RESULTS: Local recurrence was diagnosed in 14 patients (0.22%) who met the absolute indications and 53 patients (1.26%) who met the expanded indications. The rate of local recurrence was significantly higher in patients with expanded-indication lesions (p < 0.05). As additional treatment for recurrence, most patients received endoscopic treatment. Metastatic recurrence did not develop in any patient with absolute-indication lesions, but was diagnosed in 6 patients (0.14%) with expanded-indication lesions (p < 0.05). The histological type was undifferentiated mixed type in half the patients. Three patients died of primary gastric cancer. CONCLUSIONS: ESD for expanded-indication lesions of EGC is considered an effective therapy associated with an extremely low rate of metastatic recurrence on long-term follow-up. However, fully informed consent concerning the risk of metastatic recurrence should be obtained before ESD, and close postoperative follow-up is essential.
OBJECTIVE: The indications for endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC) have been expanded. However, the long-term outcomes of ESD remain unclear. We retrospectively investigated the long-term outcomes of ESD in patients with EGC. METHODS: We retrospectively studied patients with EGC who underwent ESD at 11 institutions between January 2003 and December 2010. A total of 6456 patients (7979 lesions) who met the absolute indications for ESD and 4202 patients (5781 lesions) who met the expanded indications for ESD were studied. Clinicopathological features, clinical course, and outcomes were studied in 67 patients in whom local recurrence or metastatic recurrence was diagnosed as of March 31, 2014. The median follow-up period was 56 months. RESULTS: Local recurrence was diagnosed in 14 patients (0.22%) who met the absolute indications and 53 patients (1.26%) who met the expanded indications. The rate of local recurrence was significantly higher in patients with expanded-indication lesions (p < 0.05). As additional treatment for recurrence, most patients received endoscopic treatment. Metastatic recurrence did not develop in any patient with absolute-indication lesions, but was diagnosed in 6 patients (0.14%) with expanded-indication lesions (p < 0.05). The histological type was undifferentiated mixed type in half the patients. Three patients died of primary gastric cancer. CONCLUSIONS: ESD for expanded-indication lesions of EGC is considered an effective therapy associated with an extremely low rate of metastatic recurrence on long-term follow-up. However, fully informed consent concerning the risk of metastatic recurrence should be obtained before ESD, and close postoperative follow-up is essential.
Entities:
Keywords:
Absolute-indication lesions; ESD; Early gastric cancer; Expanded-indication lesions; Outcomes
Authors: A Imagawa; H Okada; Y Kawahara; R Takenaka; J Kato; H Kawamoto; S Fujiki; R Takata; T Yoshino; Y Shiratori Journal: Endoscopy Date: 2006-10 Impact factor: 10.093