Shria Kumar1, David C Metz1, Vinay Chandrasekhara2, David E Kaplan1,3, David S Goldberg4,5. 1. Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania. 2. Division of Gastroenterology, Mayo Clinic. 3. Division of Gastroenterology, Veterans Health Administration. 4. Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine. 5. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania.
Abstract
Background and Aims: Recent studies show promise for endoscopic submucosal dissection (ESD) in the US, but do not identify the potential impact of ESD among newly diagnosed gastric cancers. We utilize the Veterans Health Administration to identify cancers suitable for ESD, to define the role of ESD in the US. Methods: Retrospective cohort study using the Veterans Affairs Central Cancer Registry to identify patients with gastric cancer who underwent surgical resection from 1995-2018. TNM stage was used to categorize those who would meet absolute vs expanded indications for ESD. Primary outcome was lymph node status. Secondary analysis was performed with death as outcome. Results: Of 12,584 primary gastric cancers, 4,735 (37.6%) were non-metastatic gastric adenocarcinomas. Median age at diagnosis was 70.3 years, 4,676 (98.8%) male. 2,306 (48.7%) underwent surgical resection, of which 636 (27.6%) were T1 lesions or cancer in situ. Of these, 44 (6.9%) met absolute indications for resection, 99 (15.6%) met established expanded criteria, and 98 (15.4%) may meet expanded criteria. Half of all tumors in each group were proximal in location.Rate of lymph node positivity was: 4.5%; 95% CI:0.5-15.5% in absolute group; 8.1%; 95% CI:3.6-15.3% in expanded group; 13.3%; 95% CI:7.3-21.6 in those potentially meeting expanded criteria. Lymph nodes positivity was associated with death (HR 1.49; 95% CI:1.36-1.62, p<0.001). Conclusions: Less than 10% of T1 or in situ cancers meet absolute criteria for ESD. Those that meet expanded criteria had higher risk for lymph node metastases, particularly proximal tumors. Future studies should evaluate the safety of ESD in proximal gastric tumors.
Background and Aims: Recent studies show promise for endoscopic submucosal dissection (ESD) in the US, but do not identify the potential impact of ESD among newly diagnosed gastric cancers. We utilize the Veterans Health Administration to identify cancers suitable for ESD, to define the role of ESD in the US. Methods: Retrospective cohort study using the Veterans Affairs Central Cancer Registry to identify patients with gastric cancer who underwent surgical resection from 1995-2018. TNM stage was used to categorize those who would meet absolute vs expanded indications for ESD. Primary outcome was lymph node status. Secondary analysis was performed with death as outcome. Results: Of 12,584 primary gastric cancers, 4,735 (37.6%) were non-metastatic gastric adenocarcinomas. Median age at diagnosis was 70.3 years, 4,676 (98.8%) male. 2,306 (48.7%) underwent surgical resection, of which 636 (27.6%) were T1 lesions or cancer in situ. Of these, 44 (6.9%) met absolute indications for resection, 99 (15.6%) met established expanded criteria, and 98 (15.4%) may meet expanded criteria. Half of all tumors in each group were proximal in location.Rate of lymph node positivity was: 4.5%; 95% CI:0.5-15.5% in absolute group; 8.1%; 95% CI:3.6-15.3% in expanded group; 13.3%; 95% CI:7.3-21.6 in those potentially meeting expanded criteria. Lymph nodes positivity was associated with death (HR 1.49; 95% CI:1.36-1.62, p<0.001). Conclusions: Less than 10% of T1 or in situ cancers meet absolute criteria for ESD. Those that meet expanded criteria had higher risk for lymph node metastases, particularly proximal tumors. Future studies should evaluate the safety of ESD in proximal gastric tumors.
Entities:
Keywords:
endoscopic resection; endoscopic submucosal dissection; gastric cancer
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