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Clinical outcomes of no residual disease in the specimen after endoscopic resection for gastric neoplasms

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Abstract

Background

No residual disease (NRD) can be found in the specimen after endoscopic resection (ER) of biopsy-proven gastric neoplasm. This study aimed to evaluate the endoscopic and pathologic characteristics of patients with NRD and identify the cause and long-term prognosis.

Methods

Medical records of patients who underwent ER for biopsy-proven gastric neoplasms at a single tertiary hospital between January 2005 and November 2014 were retrospectively reviewed. Patients whose post-ER histology was revealed as NRD were included. Overall incidence, clinicopathologic characteristics, cause, and long-term prognosis were analyzed.

Results

NRD was detected in 143 (3.2 %) of 4401 cases of gastric neoplasms treated with ER. Mean endoscopic size of the initial lesion was 8.15 ± 6.64 mm; in 93 cases (65.0 %), the lesion was located in the lower third of the stomach. Initial pathologic diagnosis was as follows: adenoma (n = 110), carcinoma (n = 29), and atypical gland (n = 4). The causes of NRD were minute lesions removed by biopsy in 140 patients, pathologic misdiagnoses in two, and localization error in one. Local recurrence was detected in five patients (3.6 %) with minute lesions during follow-up and treated with argon plasma coagulation (n = 4) or re-ER (n = 1). Synchronous (n = 5, 3.6 %) and metachronous gastric lesions (n = 6, 4.3 %) were also detected during follow-up.

Conclusions

The main cause of NRD was minute lesions which might be completely removed by initial diagnostic biopsy. These cases showed a minimal rate of local recurrence and synchronous or metachronous gastric neoplasms. Careful follow-up is also mandatory for detection of residual disease.

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References

  1. Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F (2014) Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev 23:700–713

    Article  PubMed Central  PubMed  Google Scholar 

  2. Choi IJ (2009) Gastric cancer screening and diagnosis. Korean J Gastroenterol 54:67–76

    Article  PubMed  Google Scholar 

  3. Siewert JR (2005) Gastric cancer: the dispute between East and West. Gastric Cancer 8:59–61

    Article  PubMed  Google Scholar 

  4. Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11

    Article  PubMed  Google Scholar 

  5. Tanaka M, Ono H, Hasuike N, Takizawa K (2008) Endoscopic submucosal dissection of early gastric cancer. Digestion 77(Suppl 1):23–28

    Article  PubMed  Google Scholar 

  6. Cho SJ, Choi IJ, Kim CG, Lee JY, Kook MC, Park S, Ryu KW, Lee JH, Kim YW (2011) Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification. Endoscopy 43:465–471

    Article  PubMed  Google Scholar 

  7. Choi CW, Kim HW, Shin DH, Kang DH, Hong YM, Park JH, Park SB, Cho M, Lee JH (2014) The risk factors for discrepancy after endoscopic submucosal dissection of gastric category 3 lesion (low grade dysplasia). Dig Dis Sci 59:421–427

    Article  PubMed  Google Scholar 

  8. Kim ES, Jeon SW, Park SY, Park YD, Chung YJ, Yoon SJ, Lee SY, Park JY, Bae HI, Cho CM, Tak WY, Kweon YO, Kim SK, Choi YH (2009) Where has the tumor gone? The characteristics of cases of negative pathologic diagnosis after endoscopic mucosal resection. Endoscopy 41:739–745

    Article  CAS  PubMed  Google Scholar 

  9. Kwon MJ, Park JJ, Yun JW, Noh HJ, Yoon DW, Chang WJ, Oh HY, Kim BH, Lee H, Joo MK, Lee BJ, Kim JH, Yeon JE, Kim JS, Byun KS, Bak YT (2012) Clinicopathologic features of cases with negative pathologic results after endoscopic submucosal dissection. Korean J Gastroenterol 59:211–217

    Article  PubMed  Google Scholar 

  10. Moertel CG (1977) Multiple primary malignant neoplasms: historical perspectives. Cancer 40:1786–1792

    Article  CAS  PubMed  Google Scholar 

  11. Japanese Gastric Cancer A (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  12. Participants in the Paris Workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 58:S3–43

    Article  Google Scholar 

  13. Ng TM, Fock KM, Khor JL, Teo EK, Sim CS, Tan AL, Machin D (2000) Non-steroidal anti-I nflammatory drugs, Helicobacter pylori and bleeding gastric ulcer. Aliment Pharmacol Ther 14:203–209

    Article  CAS  PubMed  Google Scholar 

  14. Choi J, Kim SG, Im JP, Kim JS, Jung HC, Song IS (2011) Endoscopic prediction of tumor invasion depth in early gastric cancer. Gastrointest Endosc 73:917–927

    Article  PubMed  Google Scholar 

  15. Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39:58–62

    Article  CAS  PubMed  Google Scholar 

  16. Yang HJ, Kim SG, Lim JH, Choi J, Im JP, Kim JS, Kim WH, Jung HC (2014) Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer. Surg Endosc. doi:10.1007/s00464-014-3780-7

    Google Scholar 

  17. Yoon H, Kim SG, Choi J, Im JP, Kim JS, Kim WH, Jung HC (2013) Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer. Surg Endosc 27:1561–1568

    Article  PubMed  Google Scholar 

  18. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  PubMed  Google Scholar 

  19. Muehldorfer SM, Stolte M, Martus P, Hahn EG, Ell C, Multicenter Study Group (2002) Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: a prospective multicentre study. Gut 50:465–470

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Genta RM, Rugge M (2006) Assessing risks for gastric cancer: new tools for pathologists. World J Gastroenterol 12:5622–5627

    PubMed Central  PubMed  Google Scholar 

  21. Noffsinger A, Waxman I (2007) Preinvasive neoplasia in the stomach: diagnosis and treatment. Clin Gastroenterol Hepatol 5:1018–1023

    Article  PubMed  Google Scholar 

  22. Choi MK, Kim GH, Park do Y, Song GA, Kim DU, Ryu DY, Lee BE, Cheong JH, Cho M (2013) Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience. Surg Endosc 27:4250–4258

    Article  PubMed  Google Scholar 

  23. Jang MY, Cho JW, Oh WG, Ko SJ, Han SH, Baek HK, Lee YJ, Kim JW, Jung GM, Cho YK (2013) Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection. Korean J Intern Med 28:687–693

    Article  PubMed Central  PubMed  Google Scholar 

  24. Kim SG (2011) Endoscopic treatment for early gastric cancer. J Gastric Cancer 11:146–154

    Article  PubMed Central  PubMed  Google Scholar 

  25. Cao D, Hafez M, Berg K, Murphy K, Epstein JI (2005) Little or no residual prostate cancer at radical prostatectomy: vanishing cancer or switched specimen?: a microsatellite analysis of specimen identity. Am J Surg Pathol 29:467–473

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by a Grant from the Liver Research Institute, Seoul National University College of Medicine.

Disclosures

Drs. Ji Min Choi, Sang Gyun Kim, Hyo-Joon Yang, Joo Hyun Lim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim, Woo Ho Kim, and Hyun Chae Jung have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 110-744, Republic of Korea

    Ji Min Choi, Sang Gyun Kim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim & Hyun Chae Jung

  2. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Hyo-Joon Yang

  3. Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea

    Joo Hyun Lim

  4. Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Woo Ho Kim

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  1. Ji Min Choi
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  2. Sang Gyun Kim
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  4. Joo Hyun Lim
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  5. Jeongmin Choi
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Corresponding author

Correspondence to Sang Gyun Kim.

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Choi, J.M., Kim, S.G., Yang, HJ. et al. Clinical outcomes of no residual disease in the specimen after endoscopic resection for gastric neoplasms. Surg Endosc 30, 610–618 (2016). https://doi.org/10.1007/s00464-015-4248-0

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  • DOI: https://doi.org/10.1007/s00464-015-4248-0

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