Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer?

Background When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis...

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Bibliographic Details
Published in:Annals of surgical oncology 2019-10, Vol.26 (11), p.3636-3643
Main Authors: Hatta, Waku, Gotoda, Takuji, Oyama, Tsuneo, Kawata, Noboru, Takahashi, Akiko, Oka, Shiro, Hoteya, Shu, Nakagawa, Masahiro, Hirano, Masaaki, Esaki, Mitsuru, Matsuda, Mitsuru, Ohnita, Ken, Shimoda, Ryo, Yoshida, Motoyuki, Dohi, Osamu, Takada, Jun, Tanaka, Keiko, Yamada, Shinya, Tsuji, Tsuyotoshi, Ito, Hirotaka, Aoyagi, Hiroyuki, Nakamura, Tomohiro, Nakaya, Naoki, Shimosegawa, Tooru, Masamune, Atsushi
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Aged
Chemotherapy
Endoscopic Mucosal Resection - mortality
Endoscopy
Female
Follow-Up Studies
Gastric cancer
Gastrointestinal Oncology
Humans
Lymph nodes
Male
Medicine
Medicine & Public Health
Metastases
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local - pathology
Neoplasm Recurrence, Local - prevention & control
Neoplasm Staging
Oncology
Reoperation
Retrospective Studies
Risk factors
Risk groups
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgery
Surgical Oncology
Survival Rate
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Summary:Background When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis (LNM). Objective This study aimed to identify high-risk patients for recurrence after additional surgery for curability C-2 ESD of EGC. Methods This multicenter retrospective cohort study enrolled 1064 patients who underwent additional surgery after curability C-2 ESD for EGC. We evaluated the recurrence rate and the risk factors for recurrence after additional surgery in these patients. Results The 5-year recurrence rate after additional surgery was 1.3%. Multivariate Cox analysis revealed that the independent risk factors for recurrence after additional surgery were LNM (hazard ratio [HR] 32.47; p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-019-07579-2