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Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea
Si Hyung Lee, Min Cheol Kim, Seong Woo Jeon, Kang Nyeong Lee, Jong Jae Park, Su Jin Hong, Korean Society of Gastrointestinal Endoscopy Endoscopic Submucosal Dissection Research Group
Clin Endosc 2020;53(2):196-205.   Published online October 25, 2019
DOI: https://doi.org/10.5946/ce.2019.123
AbstractAbstract PDFPubReaderePub
Background
/Aims: The purpose of this study was to investigate the risk factors and long-term clinical outcomes of non-curative resection (NCR) in a large-scale patient population.
Methods
We retrospectively analyzed the clinical data of 3,094 patients who underwent endoscopic submucosal dissection (ESD) of early gastric cancer from March 2005 to March 2018 at 13 institutions in Korea. We analyzed the risk factors for NCR and the survival between patients with curative resection and those with NCR with no additional treatment.
Results
The NCR rate was 21.4% (661/3,094). In multivariate regression analysis, the risk factors affecting NCR with ESD were old age, undifferentiated tumor, tumor location in the upper body, tumor size ≥2 cm, and presence of an ulcer. In Cox proportional hazard regression analysis, tumor size ≥2 cm, submucosal invasion, positive horizontal margin, and lymphovascular invasion were risk factors for local recurrence. In Kaplan-Meier analysis, there was no statistically significant difference in the overall survival between the two groups (log-rank p=0.788). However, disease-specific survival was significantly lower in the NCR group (log-rank p=0.038).
Conclusions
Clinicians should be aware of the risk factors for NCR and local recurrence after ESD for early gastric cancer, and should consider providing additional treatment after NCR.

Citations

Citations to this article as recorded by  
  • Pathology Reporting of Gastric Endoscopic Resections: Recommendations From the International Collaboration on Cancer Reporting
    Chanjuan Shi, Fleur Webster, Iris D. Nagtegaal, Michael J. Bourke, Seung-mo Hong, M. Priyanthi Kumarasinghe, Alfred K. Lam, Gregory Lauwers, Maria O’Donovan, Rachel S. van der Post, Tetsuo Ushiku, Michael Vieth, Christina Selinger
    Gastroenterology.2023; 164(7): 1039.     CrossRef
  • Nomogram for pre-procedural prediction of non-curative endoscopic resection in patients with early gastric cancer
    So Young Han, Hong Jin Yoon, Jie-Hyun Kim, Hye Sun Lee, Jaeyoung Chun, Young Hoon Youn, Hyojin Park
    Surgical Endoscopy.2023; 37(6): 4594.     CrossRef
  • Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
    Gwang Ha Kim
    World Journal of Gastroenterology.2023; 29(43): 5800.     CrossRef
  • Cancer Patient Perception Survey to Develop Korean Medicine Clinical Practice Guidelines for Gastric Cancer
    Dong Hyeon Kim, Jong Hee Kim, Ji Hye Park, Hwa Seung Yoo, Hyeong Joon Jeon, So Jung Park
    Journal of Physiology & Pathology in Korean Medicine.2023; 37(4): 81.     CrossRef
  • Endoscopic treatment for early gastric cancer
    Ji Yong Ahn
    Journal of the Korean Medical Association.2022; 65(5): 276.     CrossRef
  • Therapeutic approach to non-curative resection after endoscopic treatment in early gastric cancer
    Eun Jeong Gong, Chang Seok Bang
    Journal of the Korean Medical Association.2022; 65(5): 284.     CrossRef
  • Endoscopic diagnosis of early gastric cancer
    Dong Chan Joo, Gwang Ha Kim
    Journal of the Korean Medical Association.2022; 65(5): 267.     CrossRef
  • Long‑term outcome of the endoscopic submucosal dissection of early gastric cancer: A comparison between patients with and without liver cirrhosis
    Seung Kim, Moon Joo, Ah-Young Yoo, Seong Kim, Won Kim, Beom Lee, Jong Park, Hoon Chun, Sang Lee
    Oncology Letters.2022;[Epub]     CrossRef
  • Clinico-pathologic determinants of non-e-curative outcome following en-bloc endoscopic submucosal dissection in patients with early gastric neoplasia
    Kidane Siele Embaye, Chao Zhang, Matiwos Araya Ghebrehiwet, Zhihao Wang, Fengdi Zhang, Liwei Liu, Shenghui Qin, Lingzhi Qin, Jun Wang, Xi Wang
    BMC Cancer.2021;[Epub]     CrossRef
  • Factors associated with overall survival in early gastric cancer patients who underwent additional surgery after endoscopic submucosal dissection
    Zhi Zheng, Fan-Di Bu, Hao Chen, Jie Yin, Rui Xu, Jun Cai, Jun Zhang, Hong-Wei Yao, Zhong-Tao Zhang
    World Journal of Clinical Cases.2021; 9(10): 2192.     CrossRef
  • Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study
    Chang Seok Bang, Ji Yong Ahn, Jie-Hyun Kim, Young-Il Kim, Il Ju Choi, Woon Geon Shin
    Journal of Medical Internet Research.2021; 23(4): e25053.     CrossRef
  • Population Attributable Fraction of Helicobacter pylori Infection–Related Gastric Cancer in Korea: A Meta-Analysis
    Yoon Park, Moran Ki
    Cancer Research and Treatment.2021; 53(3): 744.     CrossRef
  • Very low rate of residual neoplasia after non-curative endoscopic submucosal dissection: a western single-center experience
    João Santos-Antunes, Margarida Marques, Fátima Carneiro, Guilherme Macedo
    European Journal of Gastroenterology & Hepatology.2021; 33(9): 1161.     CrossRef
  • Editors' Choice of Noteworthy Clinical Endoscopy Publications in the First Decade
    Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
    Clinical Endoscopy.2021; 54(5): 633.     CrossRef
  • Non-Curative Resection: Should Clinicians Consider Providing Additional Surgery for All Patients?
    Waku Hatta, Takuji Gotoda, Atsushi Masamune
    Clinical Endoscopy.2020; 53(2): 109.     CrossRef
  • Protocol for expanded indications of endoscopic submucosal dissection for early gastric cancer in China: a multicenter, ambispective, observational, open-cohort study
    Zhi Zheng, Jie Yin, Ziyu Li, Yingjiang Ye, Bo Wei, Xin Wang, Yantao Tian, Mengyi Li, Qian Zhang, Na Zeng, Rui Xu, Guangyong Chen, Jie Zhang, Peng Li, Jun Cai, Hongwei Yao, Jun Zhang, Zhongtao Zhang, Shutian Zhang
    BMC Cancer.2020;[Epub]     CrossRef
  • Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection


    Ping Xu, Yun Wang, Yini Dang, Qin Huang, Jianhua Wang, Weifeng Zhang, Yifeng Zhang, Guoxin Zhang
    Cancer Management and Research.2020; Volume 12: 8037.     CrossRef
  • 5,789 View
  • 316 Download
  • 17 Web of Science
  • 17 Crossref
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Efficacy of the Over-the-Scope Clip System for Treatment of Gastrointestinal Fistulas, Leaks, and Perforations: A Korean Multi-Center Study
Hang Lak Lee, Joo Young Cho, Jun-Hyung Cho, Jong Jae Park, Chan Gyoo Kim, Seong Hwan Kim, Joung-Ho Han
Clin Endosc 2018;51(1):61-65.   Published online August 29, 2017
DOI: https://doi.org/10.5946/ce.2017.027
AbstractAbstract PDFPubReaderePub
Background
/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea.
Methods
This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure.
Results
A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone.
Conclusions
The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.

Citations

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    Clinical Endoscopy.2021; 54(5): 633.     CrossRef
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Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis
Chang Seok Bang, Jae Myung Park, Gwang Ho Baik, Jong Jae Park, Moon Kyung Joo, Jae Young Jang, Seong Woo Jeon, Suck Chei Choi, Jae Kyu Sung, Kwang Bum Cho
Clin Endosc 2017;50(6):569-577.   Published online July 25, 2017
DOI: https://doi.org/10.5946/ce.2017.017
AbstractAbstract PDFPubReaderePub
Background
/Aims: To assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology.
Methods
Cases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed.
Results
From 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years).
Conclusions
ER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.

Citations

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  • 7,198 View
  • 329 Download
  • 27 Web of Science
  • 28 Crossref
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