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PLoS One. 2018 Oct 24;13(10):e0206179. doi: 10.1371/journal.pone.0206179. eCollection 2018.

Preprocedural prediction of non-curative endoscopic submucosal dissection for early gastric cancer.

Author information

1
Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
2
Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Pusan, Korea.

Abstract

BACKGROUND AND AIM:

Endoscopic submucosal dissection (ESD) has been accepted as the treatment of choice for early gastric cancer (EGC) without lymph node metastasis. However, additional surgical gastrectomy should be considered after non-curative endoscopic resection. We aimed to evaluate the predictive factors associated with non-curative endoscopic resection.

METHODS:

Between November 2008 and June 2015, a retrospective study was conducted in a single, tertiary, referral hospital. A total of 596 EGC lesions resected by ESD were analyzed. Non-curative endoscopic resection was defined as the occurrence of lesions associated with piecemeal resection, positive resection margins, lymphovascular invasion, or lesions that did not meet the expanded indications for ESD.

RESULTS:

The rate of non-curative endoscopic resection was 16.1%. The mean follow-up period was 35.3 ± 25.0 months. Associated predictive factors for non-curative endoscopic resection were female sex (OR, 2.470; p = 0.004), lesion size ≥ 20 mm (OR 3.714; p < 0.001), longer procedure time (OR 2.449, p = 0.002), ulceration (OR 3.538, p = 0.002), nodularity (OR 2.967, p<0.001), depression (OR 1.806, p = 0.038), undifferentiated carcinoma (OR 2.825, p = 0.031) and lesion located in the mid or upper third of stomach (OR 7.135 and OR 4.155, p<0.001, respectively). As the number of risk factors increased, the risk of non-curative ESD also increased.

CONCLUSIONS:

Prior to selection of ESD, the risks associated with non-curative ESD should be considered so that appropriate treatment modalities may be selected.

PMID:
30356294
PMCID:
PMC6200255
DOI:
10.1371/journal.pone.0206179
[Indexed for MEDLINE]
Free PMC Article

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