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Dig Endosc. 2018 Jul 30. doi: 10.1111/den.13246. [Epub ahead of print]

Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: 'Real-world evidence' in Japan.

Author information

1
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
2
Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Osaka, Japan.
3
Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.
4
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
5
Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
6
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
7
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
8
Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
9
Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.
10
Department of Endoscopy, Hiroshima City Hospital, Hiroshima, Japan.
11
Department of Endoscopy, Kobe University Hospital, Kobe, Japan.
12
Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
13
Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan.
14
Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan.
15
Division of Gastroenterology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
16
Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
17
Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan.
18
Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan.
19
Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan.
20
Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama, Japan.
21
Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan.
22
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
23
Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
24
Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan.
25
Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
26
Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan.
27
Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan.
28
Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
29
Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
30
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
31
Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
32
Department of Advanced Medicine, Research and Development Center for New Medical Frontiers, Kitasato University, Sagamihara, Japan.
33
Center for Digestive Diseases Tonan Hospital, Sapporo, Japan.
34
Digestive Disease Center, Hiroshima Memorial Hospital, Hiroshima, Japan.

Abstract

OBJECTIVES:

A Japanese multicenter prospective cohort study examining endoscopic resection (ER) for early gastric cancer (EGC) has been conducted using a Web registry developed to determine the short-term and long-term outcomes based on absolute and expanded indications. We hereby present the short-term outcomes of this study.

METHODS:

All consecutive patients with EGC or suspected EGC undergoing ER at 41 participating institutions between July 2010 and June 2012 were enrolled and prospectively registered into the Web registry. The baseline characteristics were entered before ER, and the short-term outcomes were collected at 6 months following ER.

RESULTS:

Nine thousand six hundred and sixteen patients with 10 821 lesions underwent ER (endoscopic submucosal dissection [ESD]: 99.4%). The median procedure time was 76 min, and R0 resections were achieved for 91.6% of the lesions. Postoperative bleeding and intraoperative perforation occurred in 4.4% and 2.3% of the patients, respectively. Significant independent factors correlated with a longer procedure time (120 min or longer) were as follows: tumor size >20 mm, upper-third location, middle-third location, local recurrent lesion, ulcer findings, gastric tube, male gender, and submucosa. Histopathologically, 10 031 lesions were identified as common-type gastric cancers. The median tumor size was 15 mm. Noncurative resections were diagnosed for 18.3% of the lesions. Additional surgery was performed for 48.6% (824 lesions) of the 1695 noncurative ER lesions with a possible risk of lymph node (LN) metastasis. Among them, 64 (7.8%) exhibited LN metastasis.

CONCLUSIONS:

This multicenter prospective study showed favorable short-term outcomes for gastric ESD.

KEYWORDS:

early gastric cancer; endoscopic resection; multicenter prospective study; real-world evidence; short-term outcome

PMID:
30058258
DOI:
10.1111/den.13246

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