Surgery boosts gastric cancer survival after noncurative endoscopic resection

Reuters Health Information: Surgery boosts gastric cancer survival after noncurative endoscopic resection

Surgery boosts gastric cancer survival after noncurative endoscopic resection

Last Updated: 2017-11-02

By David Douglas

NEW YORK (Reuters Health) - Additional surgery after noncurative endoscopic submucosal dissection (ESD) for early gastric cancer is associated with improved survival, according to a study from Korea.

In their October 13 online article in Gastrointestinal Endoscopy, Dr. Jun Chul Park of Yonsei University College of Medicine, Seoul, and colleagues note that although ESD use has expanded and endoscopic techniques have improved in recent years, the rate of incomplete resection has increased and "there are no definite standard treatments for noncurative resection after ESD."

To bolster the existing evidence, the team retrospectively analyzed data from 512 patients (mean age, 62.5) who had undergone noncurative resection, defined as histological positivity of the resected margins, lymphovascular infiltration, or indications beyond the expanded criteria for ESD.

During a mean follow-up of 6.5 years, 264 patients (51.6%) underwent additional surgery, 50 (9.8%) underwent further ESD, and 198 (38.7%) remained under observation.

In all, 84% of patients who underwent additional surgery were deemed to have no residual tumor, compared to 57% of patients who had ESD redone.

Cancer-specific survival was significantly higher in the additional surgery group (97%) than in the ESD-redo group (87%) and the observational group (86%). Disease-free survival rates were 93%, 74%, and 63%, respectively.

Among a subgroup of 89 low-risk patients (those with a positive lateral resection margin alone), disease-free survival was significantly higher with ESD-redo than mere observation (89% vs. 69%). On multivariate analysis, additional endoscopic treatment within 3 months was associated with a significantly diminished risk of local recurrence.

The researchers conclude that of the options examined, surgery provided the best long-term outcome. However, they note that 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."

Dr. Takeshi Sano, chief of the gastroenterological center of the Cancer Institute Hospital in Tokyo, told Reuters Health by email, "Endoscopic resection (ER) for early gastric cancer (EGC) is widely performed in Japan and Korea where EGC is frequently detected, and excellent long-term results have been reported. . . . Unfortunately, EGC detection in Western countries is rather rare, and ER is available only in some highly specialized centers."

The current study, he added, "focuses on further rare cases in which an ER was performed, but the histological examination of the resected specimen showed some unfavorable features. In such cases, the choice of subsequent therapy may be debatable, and the message of this paper will be helpful for Japanese and Korean gastroenterologists who often perform ER."

Dr. Park did not respond to requests for comment.


Gastrointest Endosc 2017.

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