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- Title
Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection.
- Authors
Kawata, Noboru; Kakushima, Naomi; Takizawa, Kohei; Tanaka, Masaki; Makuuchi, Rie; Tokunaga, Masanori; Tanizawa, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Sugino, Takashi; Kusafuka, Kimihide; Shimoda, Tadakazu; Nakajima, Takashi; Terashima, Masanori; Ono, Hiroyuki
- Abstract
<bold>Background: </bold>The long-term outcomes after non-curative gastric endoscopic submucosal dissection (ESD) are still unknown. We aimed to clarify the pathological risk factors for lymph node metastasis (LNM) of early gastric cancer (EGC) and the long-term outcomes among patients who were judged to have had non-curative ESD.<bold>Methods: </bold>From September 2002 to December 2012, 506 patients who were judged to have had non-curative gastric ESD were enrolled and classified into two groups: (1) those who subsequently underwent additional surgical resection (surgical group, n = 323) and (2) those followed up without additional surgical resection (nonsurgical group, n = 183). We analyzed pathological risk factors for LNM of EGC in the surgical group. Additionally, we compared long-term outcomes in the two groups.<bold>Results: </bold>LNM was found pathologically in 9.3 % of the surgical group (30/323) at the additional surgical resection after non-curative ESD. In the multivariate logistic regression analysis, lymphovascular invasion (LVI) was an independent risk factor for LNM in the surgical group (odds ratio 8.57, 95 % confidence interval 2.76-38.14, P < 0.0001). The 5-year cause-specific survival rate was similar in the surgical and nonsurgical groups (98.7 and 96.5 %, respectively; log-rank test, P = 0.07). In contrast, the 5-year cause-specific survival rate of patients with LVI in the surgical group was better than that in the nonsurgical group (98.2 and 79.1 %, respectively; log-rank test, P < 0.0001).<bold>Conclusions: </bold>A detailed assessment of LVI is essential to the pathological evaluation of endoscopically resected specimens. An additional surgical resection should be strongly recommended for patients with LVI.
- Subjects
CANCER diagnosis; STOMACH cancer; STOMACH cancer treatment; STOMACH cancer patients; LYMPH node diseases; LYMPH node surgery
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2017, Vol 31, Issue 4, p1607
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-016-5148-7