Motohiro Hirao1, Takuya Yamada2, Tomoki Michida3, Kazuhiro Nishikawa1, Takuya Hamakawa1, Eiji Mita4, Masayuki Mano5, Mitsugu Sekimoto1. 1. Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan. 2. Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan. 3. Department of Gastroenterology, Teikyo University Chiba Medical Center, Chiba, Japan. 4. Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, Osaka, Japan. 5. Department of Central Laboratory and Surgical Pathology, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
Abstract
BACKGROUND/AIMS: Since the risk of cancer cells seeding the peritoneum after perforation during endoscopic submucosal dissection (ESD) is unclear, we retrospectively examined peritoneal relapse after gastric perforation during ESD for gastric cancer at a single institution. METHODS: Of 876 patients who underwent ESD for early gastric cancer between January 2002 and December 2015, 22 patients (2.5%) experienced gastric perforation during ESD at the Osaka National Hospital in Osaka, Japan. Clinical data from these 22 patients were reviewed for information on pathology, clinical course, and evidence of peritoneal dissemination. RESULTS: Patients were followed for a median of 55 (range 2-108) months. Two patients had peritoneal seeding following perforation during ESD. Multivariate analysis to explore the influence of clinical factors on the peritoneal seeding revealed that an intra-abdominal fluid collection on the CT imaging just after ESD, tumor location at the upper lesion of stomach, and pathologically marginal invasion were independently associated with an incidence of peritoneal relapse. CONCLUSION: Although rare, we should recognize the possibility of cancer cells seeding the peritoneum after perforation during gastric ESD.
BACKGROUND/AIMS: Since the risk of cancer cells seeding the peritoneum after perforation during endoscopic submucosal dissection (ESD) is unclear, we retrospectively examined peritoneal relapse after gastric perforation during ESD for gastric cancer at a single institution. METHODS: Of 876 patients who underwent ESD for early gastric cancer between January 2002 and December 2015, 22 patients (2.5%) experienced gastric perforation during ESD at the Osaka National Hospital in Osaka, Japan. Clinical data from these 22 patients were reviewed for information on pathology, clinical course, and evidence of peritoneal dissemination. RESULTS:Patients were followed for a median of 55 (range 2-108) months. Two patients had peritoneal seeding following perforation during ESD. Multivariate analysis to explore the influence of clinical factors on the peritoneal seeding revealed that an intra-abdominal fluid collection on the CT imaging just after ESD, tumor location at the upper lesion of stomach, and pathologically marginal invasion were independently associated with an incidence of peritoneal relapse. CONCLUSION: Although rare, we should recognize the possibility of cancer cells seeding the peritoneum after perforation during gastric ESD.