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He XJ, Wang XL, Jiang CS, Hong DG, Lin HL, Zheng YP, Li H, Chen XJ, Huang JX, Dai LS, Liu MY, Luo BX, Li DL, Li DZ, Wang W. Novel beagle model of gastric local fibrotic target lesions for the evaluation and training of endoscopic techniques. BMC Gastroenterol 2023; 23:412. [PMID: 38012582 PMCID: PMC10683295 DOI: 10.1186/s12876-023-03055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 11/18/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Novel endoscopic techniques used in the treatment of gastric lesions with local submucosal fibrosis need preclinical evaluation and training due to safety limitations. Therefore, the purpose of our study was to establish an animal model of gastric local fibrotic target lesions and assess its feasibility in the evaluation and training of endoscopic techniques. METHODS In six experimental beagles, a 50% glucose solution was injected into three submucosal areas of the fundus, body, and antrum of the stomach to create gastric local fibrotic target lesions (experimental group). On post-injection day (PID) 7, the injection sites were assessed endoscopically to confirm the presence of submucosal fibrosis formation, and the dental floss clip traction assisted endoscopic submucosal dissection (DFC-ESD) procedure was performed on the gastric local fibrotic target lesions to confirm its feasibility after endoscopic observation. The normal gastric mucosa of six control beagles underwent the same procedure (control group). All the resected specimens were evaluated by histological examination. RESULTS All 12 beagles survived without postoperative adverse events. On PID 7, 16 ulcer changes were observed at the injection sites (16/18) under the endoscope, and endoscopic ultrasonography confirmed the local submucosal fibrosis formation in all ulcer lesions. The subsequent DFC-ESD was successfully performed on the 32 gastric target lesions, and the mean submucosal dissection time in the ulcer lesions was greater than that in the normal gastric mucosa (15.3 ± 5.6 vs. 6.8 ± 0.8 min; P < 0.001). There was no difference in rates of en bloc resection, severe hemorrhage, or perforation between the two groups. Histological analysis of the ulcer lesions showed the absence of epithelial or muscularis mucosae and extensive submucosal fibrous tissue proliferations compared with normal gastric mucosa. Overall, endoscopists had high satisfaction with the realism and feasibility of the animal model. CONCLUSION We developed a novel animal model of gastric local fibrotic target lesions to simulate difficult clinical situations, which strongly appeared to be suitable for the preclinical evaluation and learning of advanced endoscopic techniques.
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Affiliation(s)
- Xiao-Jian He
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Xiao-Ling Wang
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Chuan-Shen Jiang
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Dong-Gui Hong
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Hai-Lan Lin
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Yun-Ping Zheng
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Han Li
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Xin-Jiang Chen
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Jian-Xiao Huang
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Ling-Shuang Dai
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Mei-Yan Liu
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Bao-Xiang Luo
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China
| | - Dong-Liang Li
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China.
- Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China.
| | - Da-Zhou Li
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China.
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China.
| | - Wen Wang
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China.
- Department of Digestive Diseases, 900TH Hospital of Joint Logistics Support Force, 156 North Road of West No.2 Ring, Fuzhou, 350025, China.
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Fukuhara M, Urabe Y, Oka S, Mizuno J, Tanaka H, Yamashita K, Hiyama Y, Takigawa H, Kotachi T, Yuge R, Arihiro K, Tanaka S. Outcomes of endoscopic submucosal dissection in patients who develop metachronous superficial esophageal squamous cell carcinoma close to a post-endoscopic submucosal dissection scar. Esophagus 2023; 20:124-133. [PMID: 35917040 DOI: 10.1007/s10388-022-00945-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 07/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The presence of post-endoscopic submucosal dissection (ESD) scars renders complete metachronous superficial esophageal squamous cell carcinoma resection difficult. We aimed to identify the risk factors for incomplete resection of metachronous esophageal squamous cell carcinoma close to the post-ESD scar by ESD. METHODS We enrolled patients who developed post-ESD superficial esophageal squamous cell carcinoma at Hiroshima University Hospital between January 2006 and March 2020. We analyzed the outcomes and risk factors of incomplete resection between patients whose lesions were close to (close-to group) and away from (away-from group) the post-ESD scar. RESULTS We included 111 patients with 212 lesions. The close-to group had a significantly lower complete resection rate (88.6% [62/70] vs. 98.6% [69/70], p = 0.033), longer procedure time (80.2 ± 47.2 min vs. 60.4 ± 29.3 min, p < 0.01), higher proportion of lesions with severe fibrosis (72.9% [51/70] vs. 5.7% [4/70], p < 0.01), and higher intraoperative bleeding rate (78.6% [55/70] vs. 60.0% [42/70], p = 0.027) than the away-from group. There was no significant difference in the rate of local recurrence, muscle injury, perforation, and stenosis as well as the pathological tumor depth between the groups. Of the 92 lesions in the close-to group, the proportion of lesions located on the oral side of the post-ESD scar significantly affected the incidence of incomplete resection (91.7% [11/12] vs. 53.8% [43/80], p = 0.013). CONCLUSIONS Complete resection was more difficult for lesions located on the oral side of the post-ESD scar.
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Affiliation(s)
- Motomitsu Fukuhara
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan.
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Jyunichi Mizuno
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuichi Hiyama
- Department of Clinical Research Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidehiko Takigawa
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Takahiro Kotachi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ryo Yuge
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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Xu JQ, Zhang ZC, Chen WF, Xu MD, Chen SY, Zhong YS, Zhang YQ, Hu JW, Cai MY, Yao LQ, Zhou PH, Li QL. Repeat endoscopic submucosal dissection as salvage treatment for local recurrence of esophageal squamous cell carcinoma after initial endoscopic submucosal dissection. Gastrointest Endosc 2022; 96:18-27.e1. [PMID: 35240119 DOI: 10.1016/j.gie.2022.02.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/20/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Local recurrence of esophageal squamous cell carcinoma (ESCC) after endoscopic resection does not have an established treatment. The efficacy and safety of repeat endoscopic submucosal dissection (ESD) for recurrent ESCC were determined in the study. METHODS Forty-three consecutive patients with 45 locally recurrent superficial ESCC lesions undergoing repeat ESD and 909 first ESD lesions for propensity score matching (PSM) at Zhongshan Hospital between January 2011 and January 2020 were retrospectively enrolled. After PSM (1:2), operation-related parameters were compared between repeat ESD and first ESD. In the repeat ESD group, the Kaplan-Meier method and log-rank tests were used for identification of risk factors for local recurrence after repeat ESD. RESULTS As compared with propensity score-matched first ESD, rates of complete resection (86.7% vs 97.8%, P = .02) and curative resection (86.7% vs 96.7%, P = .06) were lower and procedure duration (54.8 ± 21.7 minutes vs 46.2 ± 20.6 minutes, P = .67) and hospital stay (4.3 ± 1.8 days vs 2.9 ± 1.4 days, P = .25) were longer in the repeat ESD group. The en-bloc resection rate (93.3% vs 98.8%, P > .11) remained comparable. Adverse events including bleeding (4.4% vs 0%, P = .11), perforation (.0% vs .0%, P > .99), and stricture (6.7% vs 2.2%, P = .33) presented with no difference. The 5-year overall survival rate and recurrence-free survival rate for repeat ESD was 100% and 86.0%, respectively. Multiplicity was significantly associated with recurrence after repeat ESD (P = .01). CONCLUSIONS Repeat esophageal ESD showed favorable short- and long-term outcomes and thus provides an alternative choice for recurrent superficial ESCC.
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Affiliation(s)
- Jia-Qi Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhao-Chao Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Feng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mei-Dong Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shi-Yao Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun-Shi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Wei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Qing Yao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
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Waki K, Shichijo S, Uedo N, Takeuchi Y, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Ishihara R, Tanaka Y, Michida T. Long-term outcomes after endoscopic resection for late-elderly patients with early gastric cancer. Gastrointest Endosc 2022; 95:873-883. [PMID: 34979116 DOI: 10.1016/j.gie.2021.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS With the population aging, the incidence of early gastric cancer (EGC) is increasing. We aimed to clarify the indications for endoscopic resection (ER) in late-elderly patients with EGC in terms of life expectancy. METHODS Patients aged ≥75 years who underwent ER for EGC at our institution from January 2007 to December 2012 were enrolled. Clinical data, including Eastern Cooperative Oncology Group performance status (ECOG-PS), Charlson comorbidity index, and Prognostic Nutritional Index (PNI), were collected at the time of ER. Overall survival (OS) was the main outcome measure. RESULTS Four hundred consecutive patients were enrolled. Mean patient age was 79.3 years (range, 75-93). The 5-year follow-up rate was 89.0% (median follow-up period, 5.6 years). Five-year OS was 80.8% (95% confidence interval [CI], 76.4-84.4), and 5-year net survival standardized for age, sex, and calendar year was 1.09 (95% CI, 1.03-1.15). With a multivariate analysis, ECOG-PS 2 to 4 (hazard ratio, 8.84; 95% CI, 3.07-25.4), PNI <49.1 (hazard ratio, 2.49; 95% CI, 1.53-4.06), and eCura C-2 (hazard ratio, 1.79; 95% CI, 1.11-2.88) were independent prognostic factors. When none of these factors was met, the 5-year OS rate was 90.4% (95% CI, 84.0-94.3). CONCLUSIONS ER for EGC in late-elderly patients may improve life expectancy. ER is recommended in patients with a good ECOG-PS and PNI and in whom ER is expected to be non-eCura C-2.
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Affiliation(s)
- Kotaro Waki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan; Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshinori Takeuchi
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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Kim TS, Min BH, Min YW, Lee H, Rhee PL, Kim JJ, Lee JH. Long-term Outcomes of Additional Endoscopic Treatments for Patients with Positive Lateral Margins after Endoscopic Submucosal Dissection for Early Gastric Cancer. Gut Liver 2021; 16:547-554. [PMID: 34462393 PMCID: PMC9289831 DOI: 10.5009/gnl210203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022] Open
Abstract
Background/Aims It is uncertain whether additional endoscopic treatment may be chosen over surgery in patients with positive lateral margins (pLMs) as the only non-curative factor after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to compare the long-term outcomes of additional endoscopic treatments in such patients with those of surgery and elucidate the clinicopathological factors that could influence the treatment selection. Methods A total of 99 patients with 101 EGC lesions undergoing additional treatment after non-curative ESD with pLMs as the only non-curative factor were analyzed. Among them, 25 (27 lesions) underwent ESD, 29 (29 lesions) underwent argon plasma coagulation (APC), and 45 (45 lesions) underwent surgery. Clinicopathological characteristics and long-term outcomes were compared. Results Residual tumor was found in 73.6% of cases. The presence of multiple pLMs was associated with higher risk of residual tumor (p=0.046). During a median follow-up of 58.9 months, recurrent or residual lesions after additional ESD and APC were found in 4% (1/25) and 6.8% (2/29) of patients, respectively. However, all were completely cured with surgery or repeated ESD. There were no extragastric recurrences after additional endoscopic treatment. Lymph node metastasis was identified after additional surgery in one (2.2%) patient with an EGC showing histological heterogeneity. Conclusions Given the favorable long-term outcomes, additional ESD or APC may be an acceptable choice for patients with pLMs as the only non-curative factor after ESD for EGC. However, clincopathological characteristics such as multiple pLMs and histological heterogeneity should be considered in the treatment selection.
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Affiliation(s)
- Tae-Se Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Repeated Endoscopic Submucosal Dissection for Esophageal Neoplasia Located Close to a Previous Endoscopic Submucosal Dissection Scar. Clin Transl Gastroenterol 2021; 11:e00226. [PMID: 32955199 PMCID: PMC7423925 DOI: 10.14309/ctg.0000000000000226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION: Endoscopic submucosal dissection (ESD) could become a standard treatment for early stage esophageal neoplasia. Recurrence sometimes develops close to a previous ESD scar. These lesions are predictably difficult to treat with ESD because of severe fibrosis. We evaluated the clinical outcomes of ESD for esophageal neoplasia located close to a previous ESD scar. METHODS: This was a retrospective observational study in a single institution. A total of 549 consecutive patients with 927 esophageal lesions were treated with ESD. The primary outcomes were resectability and adverse events of esophageal neoplasia located close to previous ESD scars (ESD scar group) than in primary esophageal ESD (primary group). Furthermore, predictive factors of perforation were examined. RESULTS: A total of 545 primary and 29 ESD scars in consecutive patients were evaluated. En bloc and complete (R0) resection rates in the ESD scar group were lower than those in the primary group (79.3% vs 98.3%, P < 0.01 and 75.9% vs 93.4%, P < 0.01). Perforations occurred more frequently in the ESD scar group (10.3% vs 2.0%, P = 0.03). The ESD scar group was a predictive factor for perforation (odds ratio = 10.37, 95% confidence interval: 2.15–49.94, P = 0.004). There were similar results for inverse probability of treatment weighting methods (odds ratio = 6.78, 95% confidence interval: 1.40–32.98, P = 0.018). DISCUSSION: ESD for esophageal neoplasia located close to a previous ESD scar was difficult to completely resect and increased the likelihood of perforation but could be a treatment option.
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Tanaka H, Oka S, Tanaka S, Nagata S, Kunihiro M, Kuwai T, Hiraga Y, Mizumoto T, Okanobu H, Chayama K. Salvage endoscopic submucosal dissection for local residual/recurrent colorectal tumor after endoscopic resection: Large multicenter 10-year study. Dig Endosc 2021; 33:608-615. [PMID: 33448492 DOI: 10.1111/den.13797] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES For local residual/recurrent and endoscopic resection (ER) interrupted colorectal tumors, endoscopic retreatment is often difficult due to severe submucosal fibrosis. Endoscopic submucosal dissection (ESD) can achieve en bloc resection, even for tumors with severe submucosal fibrosis, although it is a risk factor for incomplete resection and perforation. We aimed to determine the safety and efficacy of colorectal ESD for local residual/recurrent tumors including ER interrupted tumors from a large multicenter study. METHODS From January 2008 until December 2018, 3,937 colorectal tumors were resected by ESD at the Hiroshima GI Endoscopy Research Group. From this group, 81 local residual/recurrent tumors and 21 ER interrupted tumors were included. We analyzed ESD outcomes, particularly the difference between the early and late phases and re-recurrence after ESD for local residual/recurrent tumors. RESULTS For local residual/recurrent tumors, en bloc and R0 resection rates were 95% (77/81) and 90% (73/81), respectively. The intraoperative perforation rate was 6% (5/81), and one patient required surgery. The delayed perforation rate was 2% (2/81), and one patient required surgery. For ER interrupted tumors, both the en bloc and R0 resection rates were 86% (18/21), with no major adverse events. For local residual/recurrent and ER interrupted tumors, the intraoperative perforation rate was significantly lower in the late phase compared with the early phase. Following curative resection for local residual/recurrent tumors, no local re-recurrences occurred. CONCLUSIONS Colorectal ESD is an effective treatment for local residual/recurrent and ER interrupted tumors.
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Affiliation(s)
- Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Yuko Hiraga
- Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takeshi Mizumoto
- Department of Gastroenterology, Miyoshi Central Hospital, Hiroshima, Japan
| | - Hideharu Okanobu
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Recurrence rate of intramucosal gastric cancer with positive vertical margin due to lesion damage during endoscopic submucosal dissection. Acta Gastroenterol Belg 2021; 84:289-294. [PMID: 34217177 DOI: 10.51821/84.2.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND STUDY AIM In principle, additional surgery is performed after endoscopic submucosal dissection for early gastric cancer if the vertical margin is positive, regardless of lesion damage. The recurrence rate of vertical margin-positive lesions due to lesion damage after endoscopic submucosal dissection is unknown, and unnecessary surgeries may be performed. In this study, we investigated whether there was a difference in the recurrence rate between vertical margin-positive lesions due to lesion damage and vertical margin-negative lesions. PATIENTS AND METHODS We included 1,294 intramucosal gastric cancer lesions that were resected by endoscopic submucosal dissection between January 2008 and December 2016, without additional surgery. The lesions were divided into the Damage and No damage groups based on vertical margin status. The Damage group had only one non-curative indication: a positive vertical margin due to lesion damage. The No damage group had no non curative indications. We compared the recurrence rate between the Damage and No damage groups. RESULTS The recurrence rates of the Damage and No damage groups were 0% (0/23; 95% confidence interval: 0-14.8%) and 0% (0/1,271; 95% confidence interval: 0-0.003%), respectively, with no statistically significant difference. CONCLUSIONS In intramucosal gastric cancer, the recurrence rate of vertical margin-positive lesions due to lesion damage was 0%, which did not differ from that of vertical margin-negative lesions with curative resection. Follow-up, instead of additional surgery, may be an option for patients with non-curative resection when the only non-curative indication is a positive vertical margin due to lesion damage.
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Shichijo S, Uedo N, Kanesaka T, Ohta T, Nakagawa K, Shimamoto Y, Ohmori M, Arao M, Iwatsubo T, Suzuki S, Matsuno K, Iwagami H, Inoue S, Matsuura N, Maekawa A, Nakahira H, Yamamoto S, Takeuchi Y, Higashino K, Ishihara R, Fukui K, Ito Y, Narahara H, Ishiguro S, Iishi H. Long-term outcomes after endoscopic submucosal dissection for differentiated-type early gastric cancer that fulfilled expanded indication criteria: A prospective cohort study. J Gastroenterol Hepatol 2021; 36:664-670. [PMID: 32663347 PMCID: PMC7983953 DOI: 10.1111/jgh.15182] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/21/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Endoscopic resection for early gastric cancer (EGC) is widely performed. However, there is still a paucity of strong evidence regarding long-term outcomes after endoscopic submucosal dissection (ESD) for the expanded indication criteria of the Japanese guidelines (ver. 2010). METHODS Endoscopic submucosal dissection was performed in patients with EGC that met the expanded indication criteria: (i) cT1a, differentiated-type EGC of 2 to 5 cm, ulcer negative or (ii) cT1a, differentiated-type EGC of ≤3 cm, ulcer positive. Patients whose pathological examination fulfilled the curative resection criteria were then enrolled in this cohort study: negative vertical margin, negative lymphovascular invasion, and (i) pT1a, differentiated-type, and ulcer negative; (ii) pT1a, differentiated-type, ≤3 cm, and ulcer positive; or (iii) pT1b1 (<500-μm submucosal invasion), differentiated-type, and ≤3 cm. Patients with only a positive horizontal margin as a noncurative factor were included for follow-up. RESULTS From September 2003 to February 2012, a total of 356 patients underwent ESD, and 214 were enrolled in the survival analysis. One hundred twenty patients (56%) had >2 cm in diameter and ulcer-negative lesions, and 94 (44%) had ≤3 cm and ulcer-positive lesions. The vital status at 5 years after ESD was confirmed in all (100%) patients. No local or metastatic recurrence was detected; however, 26 metachronous gastric cancers developed, and 1 patient died of metachronous gastric cancer. The 5-year disease-specific and overall survival rates were 99.5% (95% confidence interval [CI], 97.2%-100%) and 93.9% (95% CI, 89.8%-96.4%), respectively. CONCLUSION ESD for EGC that fulfills the expanded criteria is feasible and shows favorable long-term outcomes.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Noriya Uedo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Takashi Kanesaka
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Takashi Ohta
- Division of GastroenterologyKansai Rosai HospitalAmagasakiJapan
| | - Kentaro Nakagawa
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yusaku Shimamoto
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Masayasu Ohmori
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Masamichi Arao
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Taro Iwatsubo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Sho Suzuki
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kenshi Matsuno
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Shuntaro Inoue
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Noriko Matsuura
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Akira Maekawa
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroko Nakahira
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Sachiko Yamamoto
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yoji Takeuchi
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Koji Higashino
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Ryu Ishihara
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Keisuke Fukui
- Center for Cancer Control and StatisticsOsaka International Cancer InstituteOsakaJapan
- Department of Medical Statistics, Research & Development CenterOsaka Medical CollegeOsakaJapan
| | - Yuri Ito
- Center for Cancer Control and StatisticsOsaka International Cancer InstituteOsakaJapan
- Department of Medical Statistics, Research & Development CenterOsaka Medical CollegeOsakaJapan
| | - Hiroyuki Narahara
- Department of GastroenterologyHyogo Prefectural Nishinomiya HospitalNishinomiyaJapan
| | | | - Hiroyasu Iishi
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
- Department of GastroenterologyItami City HospitalItamiJapan
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10
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Ono H, Yao K, Fujishiro M, Oda I, Uedo N, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, Fujimoto K. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc 2021; 33:4-20. [PMID: 33107115 DOI: 10.1111/den.13883] [Citation(s) in RCA: 298] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
In response to the rapid and wide acceptance and use of endoscopic treatments for early gastric cancer, the Japan Gastroenterological Endoscopy Society, in collaboration with the Japanese Gastric Cancer Association, produced "Guidelines for Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Early Gastric Cancer" in 2014, as a set of basic guidelines in accordance with the principles of evidence-based medicine. At the time, a number of statements had to be established by consensus (the lowest evidence level), as evidence levels remained low for many specific areas in this field. However, in recent years, the number of well-designed clinical studies has been increasing. Based on new findings, we have issued the revised second edition of the above guidelines that cover the present state of knowledge. These guidelines are divided into the following seven categories: indications, preoperative diagnosis, techniques, evaluation of curability, complications, long-term postoperative surveillance, and histology.
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Affiliation(s)
- Hiroyuki Ono
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
| | - Kenshi Yao
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
| | - Ichiro Oda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
| | - Noriya Uedo
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Satoshi Nimura
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
| | - Naohisa Yahagi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
| | - Hiroyasu Iishi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
| | - Masashi Oka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
| | - Yoichi Ajioka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Gastric Cancer Association, Tokyo, Japan
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11
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Matsumoto R, Kanetaka K, Maruya Y, Yamaguchi S, Kobayashi S, Miyamoto D, Ohnita K, Sakai Y, Hashiguchi K, Nakao K, Eguchi S. The Efficacy of Autologous Myoblast Sheet Transplantation to Prevent Perforation After Duodenal Endoscopic Submucosal Dissection in Porcine Model. Cell Transplant 2020; 29:963689720963882. [PMID: 33121270 PMCID: PMC7784576 DOI: 10.1177/0963689720963882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/30/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
The recent advent of endoscopy has enabled the endoscopic submucosal dissection (ESD) of superficial nonampullary duodenal epithelial tumors. However, the substantially thin wall and presence of bile and pancreatic juice make it technically difficult to perform duodenal ESD without perforation, which leads to lethal complications. The present study evaluated the efficacy of autologous myoblast sheet transplantation for the prevention of late perforation after duodenal ESD in a porcine model. Two weeks before ESD, skeletal muscle was surgically excised from the femur of pigs, and myoblasts were isolated and seeded in temperature-responsive culture dishes to prepare sheets. Immediately after ESD, the autologous myoblast sheets were attached to the serosal surface at the ESD site with omentopexy. The pigs were divided into two groups: the autologous myoblast sheet group (n = 5), where the myoblast cell sheet was attached to the ESD ulcer part from the duodenal serous side, and the Omentum group (n = 5), where only the omentum was used. The pigs were sacrificed and analyzed macroscopically and histologically on postoperative day 3. The macroscopic examination of the abdominal cavity revealed perforation in the ESD ulcer area and leakage of bile in the Omentum group but no perforation in the Sheet group. A histopathological examination revealed that continuity of the duodenal wall at the ESD site was maintained with dense connective tissue in the Sheet group. In conclusion, autologous myoblast sheets were useful for preventing perforation after duodenal ESD.
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Affiliation(s)
- Ryo Matsumoto
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Tissue Engineering and Regenerative Therapeutics in Gastrointestinal Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhiro Maruya
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Tissue Engineering and Regenerative Therapeutics in Gastrointestinal Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shun Yamaguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinichiro Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Daisuke Miyamoto
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ken Ohnita
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yusuke Sakai
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keiichi Hashiguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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12
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Lee SH, Park BS. Is Radical Surgery Necessary for All Patients Diagnosed as Having Non-Curative Endoscopic Submucosal Dissection? Clin Endosc 2019; 52:21-29. [PMID: 30727716 PMCID: PMC6370927 DOI: 10.5946/ce.2019.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/21/2019] [Indexed: 12/17/2022] Open
Abstract
If a lesion does not meet the expanded indication criteria for treatment with endoscopic therapy for early gastric cancer or has a positive resection margin, it is regarded as suitable for non-curative resection. Non-curative resection is closely related to the risk of local recurrence, lymph node metastasis, and poor prognosis. If the result is confirmed as non-curative resection, additional treatment should be considered depending on the risks of residual tumor, local recurrence, and lymph node metastasis. As lymphatic invasion is the most important risk factor of recurrence and poor prognosis, surgical treatment should be considered if lymphatic invasion is present. If patients are not suitable for additional surgery owing to old age or coexisting severe disease, close surveillance can be an alternative treatment option.
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Affiliation(s)
- Si Hyung Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung Sam Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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13
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Yahagi N, Kato M, Ochiai Y, Maehata T, Sasaki M, Kiguchi Y, Akimoto T, Nakayama A, Fujimoto A, Goto O, Uraoka T. Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia. Gastrointest Endosc 2018; 88:676-682. [PMID: 29753040 DOI: 10.1016/j.gie.2018.05.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 05/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Pancreaticoduodenectomy is an invasive procedure, and endoscopic resection (ER) is an alternative therapy. However, details regarding the outcomes of ER are unknown, especially for superficial duodenal epithelial neoplasia (SDET). The aim of this study was to elucidate the outcomes of ER for SDET and to compare EMR with endoscopic submucosal dissection (ESD). METHODS This was a retrospective observational study. From June 2010 to June 2017, 320 cases of endoscopically resected SDET (146 EMR-treated cases and 174 ESD-treated cases) were included in this study. We analyzed the proportions of en bloc resection, R0 resection, perforation, and bleeding as outcomes of ER and compared outcomes between the EMR and ESD groups. Next, we collected data on the features and clinical course of cases with adverse events. RESULTS The proportions of en bloc resection and R0 resection among all cases were 96.6% and 83.4%, respectively. In over 95% of cases, ESD achieved en bloc resection, regardless of lesion size. The incidences of perforation and bleeding were 8.8% and 3.4%, respectively, and the former was largely successfully managed by conservative treatment. The mortality rate was 0%, and all patients were discharged with a median hospital stay of 8.5 days (range, 4-52 days). Evaluation of the hospital stay duration according to lesion circumference revealed a significantly longer duration for lesions present on the medial wall than for other lesions (median 41 vs 7 days, P = .0331). CONCLUSION The present study revealed that ER achieved secure en bloc resection, with the treatment type (ESD or EMR) selected according to the lesion size. A lesion located on the medial wall was associated with worse outcomes, such as prolonged hospital stay after perforation.
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Affiliation(s)
- Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yasutoshi Ochiai
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Tadateru Maehata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motoki Sasaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Kiguchi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Teppei Akimoto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Ai Fujimoto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Osamu Goto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Toshio Uraoka
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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14
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Affiliation(s)
- Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan,Corresponding author Motohiko Kato, MD, PhD Keio University School of Medicine – Cancer Center35 ShinanomachiShinjuku-ku Tokyo – Select One – 160-8582Japan+81-3-3353-6247
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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15
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Jung DH, Youn YH, Kim JH, Park JJ, Park H. Secondary endoscopic submucosal dissection for locally recurrent or incompletely resected gastric neoplasms. World J Gastroenterol 2018; 24:3776-3785. [PMID: 30197483 PMCID: PMC6127657 DOI: 10.3748/wjg.v24.i33.3776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the feasibility and safety of secondary endoscopic submucosal dissection (ESD) for residual or locally recurrent gastric tumors.
METHODS Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups.
RESULTS The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%, respectively. The average procedure time of secondary ESD was significantly longer than primary ESD (78.2 min vs 55.1 min, P = 0.004), and the adverse events rate was not significantly different but trended slightly higher in the secondary ESD group compared to the primary ESD group (10.7% vs 3.8%, P = 0.095). Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD.
CONCLUSION Secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment though it requires greater technical efficiency and longer procedure time.
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Affiliation(s)
- Da Hyun Jung
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Young Hoon Youn
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Jae Jun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Hyojin Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
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16
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Morgagni P, La Barba G, Colciago E, Vittimberga G, Ercolani G. Resection line involvement after gastric cancer treatment: handle with care. Updates Surg 2018; 70:213-223. [DOI: 10.1007/s13304-018-0552-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/01/2018] [Indexed: 02/06/2023]
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17
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Ishii N, Omata F, Fujisaki J, Hirasawa T, Kaise M, Hoteya S, Tanabe S, Ishido K, Ohata K, Takita M, Mine T, Igarashi M, Yoshida T, Takeda Y, Furumoto Y, Matsumoto K, Yahagi N, Nakashima H, Wada T, Tagata T, Mitsunaga A. Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey. Endosc Int Open 2017; 5:E354-E362. [PMID: 28484737 PMCID: PMC5419848 DOI: 10.1055/s-0043-104859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Positive horizontal margins in resected specimens are sometimes encountered after endoscopic submucosal dissection (ESD) for early gastric cancers, and appropriate treatment strategies for these cases are not established. The aim of this study was to evaluate current empirical treatments for patients with positive horizontal or indeterminable margins after ESD. Patients and methods We performed a multicenter survey and data from 14 hospitals were collected. The pooled proportions of positive horizontal or indeterminable margins and those of patients followed up without early intervention were calculated using a logistic-normal random-effects model. For calculating pooled estimates, subgroup analyses of high- and non-high-volume centers were conducted. Results A total of 11,796 ESD cases were enrolled and 229 patients (2 %) had positive horizontal or indeterminable margins. Ninety-eight cases were treated within 30 days of ESD and 131 cases were followed up without early treatments. Pooled estimates of positive margins in high- and non-high-volume centers were 1 % (95 % CI: 1 % - 2 %) and 2 % (95 % CI: 1 % - 4 %), respectively, and were not heterogeneous (P = 0.191). The proportion of patients followed up without early intervention ranged from 30 % to 100 %. The pooled estimate was 68 % (95 % CI: 50 % - 83 %). The pooled estimates of high- and non-high-volume centers were 65 % (95 % CI: 38 % - 85 %) and 72 % (95 % CI: 44 % - 89 %), respectively, and were not heterogeneous (P = 0.692). Conclusion There was insufficient consensus regarding treatment strategies used for early gastric cancer with positive horizontal or indeterminable margins after ESD. Further studies are required to establish a consensus.
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Affiliation(s)
- Naoki Ishii
- Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan,Corresponding author Naoki Ishii, MD Department of GastroenterologySt. Luke’s International Hospital9-1 Akashi-cho, Chuo-kuTokyo 104-8560Japan+81-3-3544-0649
| | - Fumio Omata
- Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Satoshi Tanabe
- Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan
| | - Kenji Ishido
- Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan
| | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Maiko Takita
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tetsuya Mine
- Department of Gastroenterology, Tokai University School of Medicine, Kanagawa, Japan
| | - Muneki Igarashi
- Department of Gastroenterology, Tokai University School of Medicine, Kanagawa, Japan
| | | | - Yuichi Takeda
- Department of Gastroenterology, Koritsu Showa Hospital, Tokyo, Japan
| | - Yohei Furumoto
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kenshi Matsumoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer center, Keio University School of Medicine, Tokyo, Japan
| | - Hirotaka Nakashima
- Department of Gastroenterology, Foundation of detection of early gastric carcinoma, Tokyo, Japan
| | - Tomonori Wada
- Department of Gastroenterology, Sanraku Hospital, Tokyo, Japan
| | - Tomoko Tagata
- Department of Endoscopy, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Atsushi Mitsunaga
- Department of Endoscopy, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
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18
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Fujishiro M, Yoshida S, Matsuda R, Narita A, Yamashita H, Seto Y. Updated evidence on endoscopic resection of early gastric cancer from Japan. Gastric Cancer 2017; 20:39-44. [PMID: 27704225 DOI: 10.1007/s10120-016-0647-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic resection for early gastric cancer (EGC) plays a central role in the treatment of EGC in Japan. However, there is still room for improvement, and it is necessary to summarize the recently obtained knowledge from Japan for further improvement. METHODS We conducted a PubMed search to select relevant articles in the 5 years until September 18, 2016, using the keywords "gastric cancer" and "endoscopic treatment," "endoscopic submucosal dissection," "endoscopic mucosal resection," or "polypectomy" and filtering article types as "clinical study" or "clinical trial." RESULTS Among the 329 articles selected automatically from the keywords "polypectomy" (1 article), "endoscopic mucosal resection" (29 articles), "endoscopic submucosal dissection" (77 articles), and "endoscopic treatment" (222 articles) in combination with "gastric cancer," 32 relevant articles from Japanese investigators were chosen. Seven articles were categorized into "equipment," 4 into "preparation and sedation," 17 into "complications and their prevention," and 4 into "therapeutic outcomes." Among them, CO2 insufflation, propofol sedation, and how to prevent post-endoscopic submucosal dissection (ESD) ulcer bleeding and achieve post-ESD ulcer healing were intensively investigated. Long-term outcomes of endoscopic mucosal resection and ESD were also reported as favorable outcomes. CONCLUSIONS Endoscopic resection for EGC is still developing toward an ideal form, pursuing a more reliable, safer, and faster minimally invasive treatment.
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Affiliation(s)
- Mitsuhiro Fujishiro
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Shuntaro Yoshida
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Matsuda
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akiko Narita
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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19
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Nakata B, Tendo M, Okuyama M, Nakahara K, Ishizu H, Masuda G, Lee T, Hori T, Ohsawa M, Sato H, Ishikawa T. Additional surgical resection after endoscopic mucosal dissection for early gastric cancer: A medium-sized hospital's experience. Int J Surg 2016; 36:335-341. [PMID: 27871804 DOI: 10.1016/j.ijsu.2016.11.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE In Japan, the majority of early gastric cancers (EGCs) are now treated with endoscopic submucosal dissection (ESD). Patients with non-curative lesions treated by ESD are advised to undergo additional surgical resection (ASR) based on guidelines from the Japan Gastroenterological Endoscopy Society (JGES) and Japanese Gastric Cancer Association (JGCA). However, many studies have demonstrated that residual cancer and lymph node metastasis are only rarely found in ASR specimens. Here we retrospectively analyzed the conditions that could enable the avoidance of unnecessary ASR. METHODS The ESD data for 114 absolute indication lesions and 26 lesions of expanded indication lesions were analyzed. The indications and the curability were evaluated according to the JGES/JGCA guidelines. RESULTS The rates of non-curative resection and ASR were significantly higher in the expanded indication group compared to the absolute indication group (26.9% and 19.2% vs. 7.9% and 0.9%, respectively). ASR was performed for six patients. Three of their ARS specimens contained neither residual cancer nor lymph node metastasis, and the pathological findings of the preceding ESD specimens deviated slightly from the curative criteria defined by the guidelines. The conditions of the lesions that did not meet the curative criteria were as follows: (1) sm1 invasion of undifferentiated-type lesion <10 mm dia., (2) 21-25 mm dia. mucosal undifferentiated-type lesion, or (3) peacemeal resection with a horizontal margin positive for the mucosal differentiated-type. CONCLUSIONS These data suggest that a close follow-up without ASR might be appropriate for patients in the above-mentioned three categories after non-curative ESD for EGC.
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Affiliation(s)
- Bunzo Nakata
- Department of Surgery, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan.
| | - Masashige Tendo
- Department of Surgery, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Masatsugu Okuyama
- Department of Gastroenterology, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Kenichi Nakahara
- Department of Gastroenterology, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Hirotaka Ishizu
- Department of Gastroenterology, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Go Masuda
- Department of Surgery, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Tomohiro Lee
- Department of Surgery, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Takeshi Hori
- Department of Surgery, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Masahiko Ohsawa
- Department of Pathology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroshi Sato
- Department of Gastroenterology, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Tetsuro Ishikawa
- Department of Surgery, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
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Ablation of residual gastric tumor by argon plasma coagulation after endoscopic resection. Surg Endosc 2016; 31:1093-1100. [DOI: 10.1007/s00464-016-5069-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/21/2016] [Indexed: 12/11/2022]
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21
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Fu QY, Cui Y, Li XB, Chen P, Chen XY. Relevant risk factors for positive lateral margin after en bloc endoscopic submucosal dissection for early gastric adenocarcinoma. J Dig Dis 2016; 17:244-51. [PMID: 26991410 DOI: 10.1111/1751-2980.12342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/06/2016] [Accepted: 03/07/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to systematically assess the relevant risk factors of positive lateral margin (LM) after en bloc resection of early gastric adenocarcinoma. METHODS A total of 242 patients who had undergone endoscopic submucosal dissection (ESD) due to early gastric lesions from January 2009 to March 2015 were included in the study. Clinicopathological features of the lesions and the risk factors related to positive LM were analyzed. RESULTS The curative rate was 82.2% and positive LM was found in 12.4% of the lesions. Univariate analysis showed that positive LM was significantly associated with the tumor location (at the upper third of the stomach), size (>3 cm), histological findings, the presence of lymphovascular invasion and deeper invasion depth. Moreover, positive LM had a higher incidence of recurrent or residual tumors. A multivariate analysis showed that the location, tumor size and histological classification of tumors were independent risk factors for positive LM. CONCLUSIONS Positive LM is closely related to the upper third of stomach, a tumor larger than 3 cm and a mixed-type carcinoma. Additionally, positive LM has a predilection for recurrent or residual tumors.
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Affiliation(s)
- Qing Yan Fu
- Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterogy and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Yun Cui
- Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterogy and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiao Bo Li
- Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterogy and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Ping Chen
- Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterogy and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiao Yu Chen
- Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterogy and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
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22
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Noh GY, Ku HR, Kim YJ, Park SC, Kim J, Han CJ, Kim YC, Yang KY. Clinical outcomes of early gastric cancer with lymphovascular invasion or positive vertical resection margin after endoscopic submucosal dissection. Surg Endosc 2014; 29:2583-9. [PMID: 25480609 DOI: 10.1007/s00464-014-3973-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/30/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND In early gastric cancer (EGC) cases with lymphovascular invasion or positive vertical margins after endoscopic submucosal dissection (ESD), additional radical gastrectomy is performed on principle. However, an additional surgery is often difficult to consider if the surgical approach itself is challenging or the patient refuses surgery. In such cases, only close surveillance is performed without additional surgical procedures. This study aimed to examine the difference in clinical prognosis of EGC cases with lymphovascular invasion or positive vertical margins after ESD either with or without surgery. METHODS We retrospectively studied 83 patients with lymphovascular invasion or positive vertical margins after ESD from July 2005 to November 2013. RESULTS Of the 83 patients, 45 (54.2%) underwent radical additional gastrectomy (surgical group) and 38 (45.8%) were under close surveillance without surgical or endoscopic treatments (close surveillance group.) The cancer-free survival period was 78.3 ± 3.4 months in the surgical group and 64.5 ± 4.6 months in the close surveillance group. The recurrence rates did not significantly differ between the 2 groups, at 7.9% in the surgical group and 6.7% in the non-surgical group. CONCLUSIONS Close surveillance may be suggested as an option for EGC patients for whom a surgical approach is difficult, who exhibit a positive vertical margin after ESD, and who have no lymphovascular or deep submucosa invasion after ESD.
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Affiliation(s)
- Geum Youb Noh
- Departments of Internal Medicine, Institute of Gastroenterology, Korea Cancer Center Hospital, 75 Nowon-ro, Nowon-gu, Seoul, 139-706, Korea,
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