PMID- 29031882
OWN - NLM
STAT- In-Process
LR  - 20180414
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 87
IP  - 4
DP  - 2018 Apr
TI  - Long-term outcomes after noncurative endoscopic resection of early gastric
      cancer: the optimal time for additional endoscopic treatment.
PG  - 1003-1013.e2
LID - S0016-5107(17)32353-2 [pii]
LID - 10.1016/j.gie.2017.10.004 [doi]
AB  - BACKGROUND AND AIMS: We aimed to evaluate long-term outcomes with noncurative
      endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and
      surveillance strategies such as the optimal time for additional endoscopic
      treatment in patients with noncurative ESD. METHODS: Of 2527 patients who
      underwent gastric ESD for EGC, 512 (20.3%) patients with noncurative resection
      were reviewed. Noncurative resection is defined as positive resected margins on
      histology, lymphovascular infiltration, or beyond the expanded criteria for ESD. 
      RESULTS: The mean +/- standard deviation follow-up duration was 79.0 +/- 55.7
      months. A total of 264 patients (51.6%) and 50 patients (9.8%) underwent surgery 
      and endoscopic treatment after noncurative resection, respectively, whereas 198
      patients (38.7%) were observed. Cancer-specific survival and disease-free
      survival rates were significantly different among the surgery, other endoscopic
      treatment, and observation groups (96.7%, 86.8%, and 86.2%, respectively; P
      =.030; and 92.5%, 73.6%, and 63.0%, respectively; P < .001). When patients who
      underwent surgery were excluded, the disease-free survival rate of recurrence was
      not significantly different between the endoscopic treatment and observation
      groups (73.6% vs 63.0%; P = .548). To exclude the potential for the presence of
      lymph node metastasis, we further analyzed disease-free survival of local
      recurrence by comparing the patients with only a positive lateral resection
      margin. The disease-free survival rate was higher in the endoscopic treatment
      group than in the observation group (89.2% vs 69.1%; P = .023). Moreover,
      additional endoscopic treatment within 3 months showed significant associations
      with lower risk of local recurrence on multivariate analysis (hazard ratio,
      0.017; 95% confidence interval, 0.002-0.260; P = .003). CONCLUSIONS: In patients 
      with noncurative ESD, additional surgery showed a better long-term outcome;
      moreover, when a positive lateral resection margin was the only noncurative
      factor, additional endoscopic treatment within 3 months could be considered to
      improve disease-free survival.
CI  - Copyright (c) 2018 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Jeon, Mi Young
AU  - Jeon MY
AD  - Division of Gastroenterology, Department of Internal Medicine, Severance
      Hospital, Institute of Gastroenterology, Yonsei University College of Medicine,
      Seoul, Korea.
FAU - Park, Jun Chul
AU  - Park JC
AD  - Division of Gastroenterology, Department of Internal Medicine, Severance
      Hospital, Institute of Gastroenterology, Yonsei University College of Medicine,
      Seoul, Korea.
FAU - Hahn, Kyu Yeon
AU  - Hahn KY
AD  - Division of Gastroenterology, Department of Internal Medicine, Severance
      Hospital, Institute of Gastroenterology, Yonsei University College of Medicine,
      Seoul, Korea.
FAU - Shin, Sung Kwan
AU  - Shin SK
AD  - Division of Gastroenterology, Department of Internal Medicine, Severance
      Hospital, Institute of Gastroenterology, Yonsei University College of Medicine,
      Seoul, Korea.
FAU - Lee, Sang Kil
AU  - Lee SK
AD  - Division of Gastroenterology, Department of Internal Medicine, Severance
      Hospital, Institute of Gastroenterology, Yonsei University College of Medicine,
      Seoul, Korea.
FAU - Lee, Yong Chan
AU  - Lee YC
AD  - Division of Gastroenterology, Department of Internal Medicine, Severance
      Hospital, Institute of Gastroenterology, Yonsei University College of Medicine,
      Seoul, Korea.
LA  - eng
PT  - Journal Article
DEP - 20171012
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
EDAT- 2017/10/17 06:00
MHDA- 2017/10/17 06:00
CRDT- 2017/10/17 06:00
PHST- 2017/05/01 00:00 [received]
PHST- 2017/10/04 00:00 [accepted]
PHST- 2017/10/17 06:00 [pubmed]
PHST- 2017/10/17 06:00 [medline]
PHST- 2017/10/17 06:00 [entrez]
AID - S0016-5107(17)32353-2 [pii]
AID - 10.1016/j.gie.2017.10.004 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2018 Apr;87(4):1003-1013.e2. doi: 10.1016/j.gie.2017.10.004.
      Epub 2017 Oct 12.