Hirotaka Ito1, Takuji Gotoda2, Tsuneo Oyama3, Noboru Kawata4, Akiko Takahashi3, Yoshikazu Yoshifuku5, Shu Hoteya6, Masahiro Nakagawa7, Waku Hatta8, Masaaki Hirano9, Mitsuru Esaki10, Mitsuru Matsuda11, Ken Ohnita12, Ryo Shimoda13, Motoyuki Yoshida14, Osamu Dohi15, Jun Takada16, Keiko Tanaka17, Shinya Yamada18, Tsuyotoshi Tsuji19, Yoshiaki Hayashi20, Naoki Nakaya21, Tomohiro Nakamura21, Tooru Shimosegawa8. 1. Department of Gastroenterology, Osaki Citizen Hospital, 3-8-1 Honami, Furukawa, Osaki, Miyagi, 989-6183, Japan. hirotakaito@mti.biglobe.ne.jp. 2. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. takujigotoda@yahoo.co.jp. 3. Division of Endoscopy, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 385-0051, Japan. 4. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan. 5. Department of Gastroenterology and Metabolism, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan. 6. Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. 7. Department of Endoscopy, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan. 8. Department of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. 9. Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu, Niigata, 943-0192, Japan. 10. Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan. 11. Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan. 12. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 952-8501, Japan. 13. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan. 14. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan. 15. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan. 16. Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan. 17. Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. 18. Department of Gastroenterology and Hepatology, Japanese Red Cross Society, Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, Kyoto, 605-0981, Japan. 19. Department of Gastroenterology, Akita City Hospital, 4-30 Matsuoka-machi, Kawamoto, Akita, Akita, 010-0933, Japan. 20. Division of Gastroenterology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, Fukui, 910-8526, Japan. 21. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan.
Abstract
BACKGROUND: Sufficient information is not available on the extent to which lymph node metastasis (LNM) and prognosis are affected by submucosal manipulation during endoscopic submucosal dissection (ESD) for submucosal invasive gastric cancer (SMGC). We aimed to identify the effects of submucosal manipulation during ESD on LNM and prognosis in patients with SMGC. METHODS: From 19 institutions in Japan, 2526 patients who failed to meet the current curative criteria for ESD between 2000 and 2011 were recruited. After exclusion, 1969 patients were remained. Based on the treatment strategy after ESD, 1064 patients underwent additional radical surgery. A total of 890 of 1064 patients with SMGC, LNM and cancer recurrence, and prognosis were retrospectively reviewed. RESULTS: The median follow-up duration was 67 months. A total of 214 patients had SM1 (depth of tumor invasion from the muscularis mucosae <500 μm) invasive cancer and 676 patients had SM2 (depth of tumor invasion from the muscularis mucosae ≥500 μm) invasive cancer. LNM was found in 84 patients (9.4%), and 14 patients (1.6%) developed cancer recurrence. The 3-year and 5-year overall survival rates were 96.1 and 91.7%, respectively. The 3-year and 5-year disease-specific survival rates were 99.3 and 98.5%, respectively. CONCLUSIONS: The rates of LNM and cancer recurrence, and prognosis of patients who underwent additional radical surgery after non-curative ESD for SMGC were excellent. Submucosal manipulation during ESD for SMGC does not seem to enhance the risk for LNM or worsen the prognosis compared to surgical series.
BACKGROUND: Sufficient information is not available on the extent to which lymph node metastasis (LNM) and prognosis are affected by submucosal manipulation during endoscopic submucosal dissection (ESD) for submucosal invasive gastric cancer (SMGC). We aimed to identify the effects of submucosal manipulation during ESD on LNM and prognosis in patients with SMGC. METHODS: From 19 institutions in Japan, 2526 patients who failed to meet the current curative criteria for ESD between 2000 and 2011 were recruited. After exclusion, 1969 patients were remained. Based on the treatment strategy after ESD, 1064 patients underwent additional radical surgery. A total of 890 of 1064 patients with SMGC, LNM and cancer recurrence, and prognosis were retrospectively reviewed. RESULTS: The median follow-up duration was 67 months. A total of 214 patients had SM1 (depth of tumor invasion from the muscularis mucosae <500 μm) invasive cancer and 676 patients had SM2 (depth of tumor invasion from the muscularis mucosae ≥500 μm) invasive cancer. LNM was found in 84 patients (9.4%), and 14 patients (1.6%) developed cancer recurrence. The 3-year and 5-year overall survival rates were 96.1 and 91.7%, respectively. The 3-year and 5-year disease-specific survival rates were 99.3 and 98.5%, respectively. CONCLUSIONS: The rates of LNM and cancer recurrence, and prognosis of patients who underwent additional radical surgery after non-curative ESD for SMGC were excellent. Submucosal manipulation during ESD for SMGC does not seem to enhance the risk for LNM or worsen the prognosis compared to surgical series.
Authors: S Folli; P Morgagni; F Roviello; G De Manzoni; D Marrelli; L Saragoni; A Di Leo; M Gaudio; O Nanni; A Carli; C Cordiano; D Dell'Amore; A Vio Journal: Jpn J Clin Oncol Date: 2001-10 Impact factor: 3.019