-
Tytuł:
-
Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer.
-
Autorzy:
-
Eom BW; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Kim YI; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Kim KH; Biometric Research Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Goyang, Republic of Korea.
Yoon HM; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Cho SJ; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Lee JY; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Kim CG; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Kook MC; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Kim YW; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Nam BH; Biometric Research Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Goyang, Republic of Korea.
Ryu KW; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
Choi IJ; Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea.
-
Źródło:
-
Gastrointestinal endoscopy [Gastrointest Endosc] 2017 Jan; Vol. 85 (1), pp. 155-163.e3. Date of Electronic Publication: 2016 Jul 25.
-
Typ publikacji:
-
Comparative Study; Journal Article
-
Język:
-
English
-
Imprint Name(s):
-
Publication: St Louis, Mo : Mosby Yearbook
Original Publication: Denver.
-
MeSH Terms:
-
Endoscopic Mucosal Resection*
Gastrectomy*
Lymph Node Excision*
Adenocarcinoma/*mortality
Adenocarcinoma/*surgery
Neoplasm Recurrence, Local/*epidemiology
Stomach Neoplasms/*mortality
Stomach Neoplasms/*surgery
Adenocarcinoma/pathology ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Propensity Score ; Reoperation ; Retrospective Studies ; Stomach Neoplasms/pathology ; Survival Rate ; Treatment Outcome
-
Entry Date(s):
-
Date Created: 20160728 Date Completed: 20170914 Latest Revision: 20220408
-
Update Code:
-
20240104
-
DOI:
-
10.1016/j.gie.2016.07.036
-
PMID:
-
27460389
-
Background and Aims: Excellent long-term outcome is expected for early gastric cancers (EGCs) after endoscopic submucosal dissection (ESD). However, if ESD is considered noncurative at the pathologic evaluation, additional surgery is recommended. We evaluated whether long-term outcome is compromised if additional surgery is not performed for EGCs that are out-of-indication.
Methods: We retrospectively analyzed a cohort of patients with EGC not meeting ESD indications whose initial treatment was either ESD (n = 219) or surgery (n = 1799). Among them, 127 patients who underwent additional surgery after initial ESD and 67 patients who did not were matched using propensity scores to patients who initially underwent standard surgery, at a 1:1 ratio. Overall mortality and gastric cancer recurrence were compared.
Results: The overall mortality and gastric cancer recurrence rates were not significantly different between the 127 patients who underwent initial ESD with additional surgery and the corresponding initial standard surgery patients. However, the overall mortality of the 67 patients who underwent ESD without additional surgery (5-year mortality, 26.0%; 95% CI, 13.5%-49.9%) was higher than that of the matched initial standard surgery patients (5-year mortality, 14.5%; 95% CI, 6.3%-33.6%; P = .04). Gastric cancer recurrence was also higher in ESD patients without additional surgery (5-year recurrence, 17.0%; 95% CI, 7.6%-37.8%) than in the matched initial surgery group (0%; P = .002). In multivariate analyses, ESD without additional surgery was a significant risk factor for overall mortality and gastric cancer recurrence.
Conclusions: Additional surgery should be encouraged after non-curative ESD to obtain long-term outcomes comparable with those of initial standard surgery. (Clinical trial registration number: NCC2015-0093.).
(Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
