Clinical outcomes of non-curative endoscopic submucosal dissection with negative resected margins for gastric cancer

• Published in: Gastrointestinal endoscopy Vol. 85; no. 6; pp. 1218 - 1224
• Main Authors: Toya, Yosuke, MD, PhD, Endo, Masaki, MD, PhD, Nakamura, Shotaro, MD, PhD, Akasaka, Risaburo, MD, PhD, Kosaka, Takashi, MD, PhD, Yanai, Shunichi, MD, PhD, Kawasaki, Keisuke, MD, PhD, Koeda, Keisuke, MD, PhD, Sugai, Tamotsu, MD, PhD, Matsumoto, Takayuki, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2017
• Subjects: Aged; Aged, 80 and over; Carcinoma - surgery; Disease-Free Survival; Endoscopic Mucosal Resection - methods; Female; Gastrectomy; Gastroenterology and Hepatology; Gastroscopy; Humans; Male; Margins of Excision; Middle Aged; Proportional Hazards Models; Retrospective Studies; Stomach Neoplasms - surgery; Survival Rate; Treatment Outcome; EGC; Japanese Gastric Cancer Association; CI; submucosal; endoscopic submucosal dissection; JGES; HR; Japan Gastroenterological Endoscopy Society; ESD; UL; hazard ratio; JGCA; confidence interval; SM; early gastric cancer; ulcerative findings
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2016.11.018

Background and Aims There has been little information about the long-term outcomes of patients with early gastric cancer (EGC) treated by non-curative endoscopic submucosal dissection (ESD) with negative resected margins (R0 resection). We aimed to compare the clinical outcomes of non-curative ESD with R0 resection between patients who underwent additional gastrectomy and those who did not. Methods Among EGC patients treated by ESD from 2002 to 2010, 66 patients were treated by non-curative ESD with R0 resection. Patients received either additional gastrectomy (group A, n = 45) or were followed up without gastrectomy (group B, n = 21). The clinicopathologic findings and the subsequent clinical course were compared between the 2 groups. Results Patients in group A were younger than those in group B (68.0 vs 71.0 years, P  = .006). The follow-up period was longer in group A than in group B (7.8 vs 5.9 years, P  = .011). The percentage of patients who died of any cause was not statistically lower in group A than in group B (13.3% vs 33.3%, P  = .06). Although the overall survival rate was higher in group A than in group B (93.3% vs 76.2%, P = .028), disease-specific survival rates did not differ between the 2 groups (97.8% vs 100%, P  = .495). A Cox proportional hazards model showed that gastrectomy was not an independent factor associated with overall survival. Conclusions Careful follow-up may be an alternative strategy to gastrectomy for a subgroup of patients treated by non-curative ESD with R0 resection.