Kohei Takizawa1, Waku Hatta2, Takuji Gotoda3, Noboru Kawata4, Masahiro Nakagawa5, Akiko Takahashi6, Mitsuru Esaki3,7, Akira Mitoro8, Shinya Yamada9, Keiko Tanaka10, Mitsuru Matsuda11, Jun Takada12, Shiro Oka13, Hirotaka Ito14, Ken Ohnita15, Ryo Shimoda16, Shu Hoteya17, Tsuneo Oyama6, Tooru Shimosegawa2. 1. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan, k.takizawa@scchr.jp. 2. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 3. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. 4. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 5. Division of Endoscopy, Hiroshima City Hospital, Hiroshima, Japan. 6. Division of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan. 7. Department of Gastroenterology, Kitakyushu Municipal Medical Center, Fukuoka, Japan. 8. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, Nara, Japan. 9. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan. 10. Department of Gastroenterology, Shinshu University School of Medicine, Nagano, Japan. 11. Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan. 12. Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan. 13. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan. 14. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 15. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan. 16. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. 17. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Abstract
BACKGROUND/AIMS: The outcomes of salvage surgery for recurrence after non-curative endoscopic submucosal dissection (ESD) without additional radical surgery for early gastric cancer (EGC) remain unclear. We determined the recurrence patterns and outcomes of salvage surgery in such cases using data from a multicenter, retrospective study. METHODS: Of 15,785 patients who underwent ESD for EGC at 19 participating institutions between January 2000 and August 2011, 1,969 failed to meet the current curative criteria after ESD. Of these, 905 patients received no additional treatment. We evaluated the pattern of recurrence, clinical course after salvage surgery, and long-term survival rate for these patients. RESULTS: Over a median 64-month follow-up period, recurrence was detected in 27 patients. Two patients with missing data were excluded. Three, seven, and 15 (60%) patients showed intragastric relapse, regional lymph node metastasis, and distant metastasis, respectively. The first line of treatment for recurrence in 1, 7, 6, and 11 patients was endoscopic treatment, salvage surgery, chemotherapy, and best supportive care, respectively. One patient survived without recurrence for 31 months after salvage surgery, one died of acute myocardial infarction 1 month after salvage surgery, and 5 showed recurrence at 0, 2, 3, 5, and 30 months after salvage surgery and eventually succumbed to the disease. The median survival times for all patients with recurrence and the 7 patients who underwent salvage surgery were 5 months after recurrence and 7 months after salvage surgery, respectively. CONCLUSION: The survival rate after salvage surgery for recurrence after non-curative ESD without additional radical surgery for EGC is quite low, with distant metastasis being the most common recurrence pattern in these cases.
BACKGROUND/AIMS: The outcomes of salvage surgery for recurrence after non-curative endoscopic submucosal dissection (ESD) without additional radical surgery for early gastric cancer (EGC) remain unclear. We determined the recurrence patterns and outcomes of salvage surgery in such cases using data from a multicenter, retrospective study. METHODS: Of 15,785 patients who underwent ESD for EGC at 19 participating institutions between January 2000 and August 2011, 1,969 failed to meet the current curative criteria after ESD. Of these, 905 patients received no additional treatment. We evaluated the pattern of recurrence, clinical course after salvage surgery, and long-term survival rate for these patients. RESULTS: Over a median 64-month follow-up period, recurrence was detected in 27 patients. Two patients with missing data were excluded. Three, seven, and 15 (60%) patients showed intragastric relapse, regional lymph node metastasis, and distant metastasis, respectively. The first line of treatment for recurrence in 1, 7, 6, and 11 patients was endoscopic treatment, salvage surgery, chemotherapy, and best supportive care, respectively. One patient survived without recurrence for 31 months after salvage surgery, one died of acute myocardial infarction 1 month after salvage surgery, and 5 showed recurrence at 0, 2, 3, 5, and 30 months after salvage surgery and eventually succumbed to the disease. The median survival times for all patients with recurrence and the 7 patients who underwent salvage surgery were 5 months after recurrence and 7 months after salvage surgery, respectively. CONCLUSION: The survival rate after salvage surgery for recurrence after non-curative ESD without additional radical surgery for EGC is quite low, with distant metastasis being the most common recurrence pattern in these cases.
Authors: Italo Beltrão Pereira Simões; Marina Alessandra Pereira; Marcus Fernando Kodama Pertille Ramos; Ulysses Ribeiro Junior; Bruno Zilberstein; Sergio Carlos Nahas; Andre Roncon Dias Journal: Arq Bras Cir Dig Date: 2022-01-31