Optimal management for patients not meeting the inclusion criteria after endoscopic submucosal dissection for gastric cancer
| Autor: | Yasuaki Nagami, Hiroaki Tanaka, Koji Sano, Hiroaki Minamino, Katsunobu Sakurai, Tetsuo Arakawa, Atsushi Yamamoto, Yoshito Yamashita, Naoshi Kubo, Kosei Hirakawa, Kazuya Muguruma, Masaichi Ohira, Hiroko Nebiki, Kazunari Tominaga, Takahiro Toyokawa |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Neoplasm Residual Endoscopic Mucosal Resection medicine.medical_treatment Endoscopic mucosal resection Adenocarcinoma 03 medical and health sciences 0302 clinical medicine Gastrectomy Risk Factors Stomach Neoplasms Internal medicine Gastroscopy medicine Carcinoma Humans Risk factor Aged Retrospective Studies Aged 80 and over business.industry General surgery Cancer Retrospective cohort study Middle Aged Hepatology medicine.disease Dissection Gastric Mucosa Lymphatic Metastasis 030220 oncology & carcinogenesis Multivariate Analysis Female 030211 gastroenterology & hepatology Surgery Lymph Nodes Neoplasm Recurrence Local business Carcinoma Signet Ring Cell |
| Zdroj: | Surgical Endoscopy. 30:2404-2414 |
| ISSN: | 1432-2218 0930-2794 |
| DOI: | 10.1007/s00464-015-4491-4 |
| Popis: | The necessity of additional gastrectomy for patients not meeting the inclusion criteria after endoscopic submu cosal dissection (ESD) is controversial. The aim of this study was to elucidate the risk factors for lymph node metastasis (LNM) and residual cancer (RC) in patients not meeting the inclusion criteria after ESD and to determine additional treatment strategies.Of 1443 gastric cancer patients who underwent ESD between 2004 and 2013, 167 patients diagnosed as having a lesion not meeting the inclusion criteria after ESD were retrospectively analyzed. Of the 167 cases, 100 cases underwent additional gastrectomy, and 67 cases were observed without surgery.Overall, 9.0 % (9/100) and 9.0 % (9/100) of patients not meeting the inclusion criteria after ESD presented with LNM and RC, respectively, but neither was observed in 83 patients (83.0 %). Multivariate analysis revealed that lymphovascular involvement (LVI) (OR 38.38; 95 % CI 1.94-761.43, p = 0.017) and undifferentiated type (OR 45.58; 95 % CI 2.88-720.94, p = 0.007) were independent risk factors for LNM, and positive horizontal margin was an independent risk factor for RC (OR 9.48; 95 % CI 1.72-52.13, p = 0.010). In differentiated types without LVI, no cases had LNM (0/38) in the additional gastrectomy group, and there was no lymph node or distant recurrence (0/39) in the observation group.Additional treatment is necessary for patients with LVI, undifferentiated type, and positive horizontal margin. Careful follow-up may be acceptable for patients with the differentiated type without LVI, especially for the elderly or patients with severe comorbidities. |
| Databáze: | OpenAIRE |
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