Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-04-20

AUTHORS

Waku Hatta, Takuji Gotoda, Tsuneo Oyama, Noboru Kawata, Akiko Takahashi, Yoshikazu Yoshifuku, Shu Hoteya, Koki Nakamura, Masaaki Hirano, Mitsuru Esaki, Mitsuru Matsuda, Ken Ohnita, Ryo Shimoda, Motoyuki Yoshida, Osamu Dohi, Jun Takada, Keiko Tanaka, Shinya Yamada, Tsuyotoshi Tsuji, Hirotaka Ito, Yoshiaki Hayashi, Tomohiro Nakamura, Tooru Shimosegawa

ABSTRACT

BackgroundAlthough radical surgery is routinely performed for patients who do not meet the curative criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) due to the risk of lymph node metastasis (LNM), this standard therapeutic option may be excessive given the lower number of patients with LNM. Therefore, we aimed to investigate long-term outcomes and validate risk factors predicting recurrence after ESD.MethodsOf 15,785 patients who underwent ESD for EGC at 19 institutions between 2000 and 2011, 1969 patients not meeting the curative criteria were included in this multi-center study. Based on the treatment strategy after ESD, patients were divided into radical surgery (n = 1064) and follow-up (no additional treatment, n = 905) groups.ResultsOverall survival (OS) and disease-specific survival (DSS) were significantly higher in the radical surgery group than in the follow-up group (p < 0.001 and p = 0.012, respectively). However, the difference in 3-year DSS between the groups (99.4 vs. 98.7 %) was rather small compared with the difference in 3-year OS (96.7 vs. 84.0 %). LNM was found in 89 patients (8.4 %) in the radical surgery group. Lymphatic invasion was found to be an independent risk factor for recurrence in the follow-up group (hazard ratio 5.23; 95 % confidence interval 2.01–13.6; p = 0.001).ConclusionsThis multi-center study, representing the largest cohort to date, revealed a large discrepancy between OS and DSS in the two groups. Since follow-up with no additional treatment after ESD may be an acceptable option for patients at low risk, further risk stratification is needed for appropriate individualized treatment strategies. More... »

PAGES

175-184

References to SciGraph publications

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  • Journal

    TITLE

    Journal of Gastroenterology

    ISSUE

    2

    VOLUME

    52

    Author Affiliations

  • Department of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, 980-8574, Sendai, Miyagi, Japan
  • Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, 101-8309, Tokyo, Japan
  • Division of Endoscopy, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, 385-0051, Saku, Nagano, Japan
  • Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan
  • Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Hiroshima, Japan
  • Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, 105-8470, Tokyo, Japan
  • Department of Internal Medicine, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, 730-8518, Hiroshima, Hiroshima, Japan
  • Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, 943-0192, Joetsu, Niigata, Japan
  • Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, 802-0077, Kitakyushu, Fukuoka, Japan
  • Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nisinagae, 930-8550, Toyama, Toyama, Japan
  • Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, 952-8501, Nagasaki, Nagasaki, Japan
  • Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1 Nabeshima, 849-8501, Saga, Saga, Japan
  • Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, 840 Shijo-Cho, 634-8522, Kashihara, Nara, Japan
  • Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Kyoto, Japan
  • Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, 501-1194, Gifu, Gifu, Japan
  • Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Nagano, Japan
  • Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, 605-0981, Kyoto, Kyoto, Japan
  • Department of Gastroenterology, Akita City Hospital, 4-30 Matsuoka-machi, Kawamoto, 010-0933, Akita, Akita, Japan
  • Department of Gastroenterology, Osaki Citizen Hospital, 3-8-1 Honami, Furukawa, 989-6183, Osaki, Miyagi, Japan
  • Division of Gastroenterology, Fukui Prefectural Hospital, 2-8-1 Yotsui, 910-8526, Fukui, Fukui, Japan
  • Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, 2-1 Seiryo-machi, Aoba-ku, 980-8573, Sendai, Miyagi, Japan
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00535-016-1210-4

    DOI

    http://dx.doi.org/10.1007/s00535-016-1210-4

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1009908803

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/27098174


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