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Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multi-center retrospective study in Japan

  • Original Article—Alimentary Tract
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Abstract

Background

Although radical surgery is routinely performed for patients who do not meet the curative criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) due to the risk of lymph node metastasis (LNM), this standard therapeutic option may be excessive given the lower number of patients with LNM. Therefore, we aimed to investigate long-term outcomes and validate risk factors predicting recurrence after ESD.

Methods

Of 15,785 patients who underwent ESD for EGC at 19 institutions between 2000 and 2011, 1969 patients not meeting the curative criteria were included in this multi-center study. Based on the treatment strategy after ESD, patients were divided into radical surgery (n = 1064) and follow-up (no additional treatment, n = 905) groups.

Results

Overall survival (OS) and disease-specific survival (DSS) were significantly higher in the radical surgery group than in the follow-up group (p < 0.001 and p = 0.012, respectively). However, the difference in 3-year DSS between the groups (99.4 vs. 98.7 %) was rather small compared with the difference in 3-year OS (96.7 vs. 84.0 %). LNM was found in 89 patients (8.4 %) in the radical surgery group. Lymphatic invasion was found to be an independent risk factor for recurrence in the follow-up group (hazard ratio 5.23; 95 % confidence interval 2.01–13.6; p = 0.001).

Conclusions

This multi-center study, representing the largest cohort to date, revealed a large discrepancy between OS and DSS in the two groups. Since follow-up with no additional treatment after ESD may be an acceptable option for patients at low risk, further risk stratification is needed for appropriate individualized treatment strategies.

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Acknowledgments

We thank Naoki Nakaya (Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization) for his insightful comments and advice regarding statistical analysis in this study. We also thank Hiroyuki Ono (Division of Endoscopy, Shizuoka Cancer Center), Masahiro Nakagawa (Department of Internal Medicine, Hiroshima City Hospital), Naohiko Harada (Department of Gastroenterology, National Hospital Organization Kyushu Medical Center), Yasumasa Hara (Department of Internal Medicine, Toyama Prefectural Central Hospital), and Kohei Yamanouchi (Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School) for their assistance with patient enrollment and data collection. Finally, we thank Tomoyuki Koike (Department of Gastroenterology, Tohoku University Graduate School of Medicine) and Katsunori Iijima (Department of Gastroenterology, Akita University Graduate School of Medicine) for their insightful comments.

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Authors and Affiliations

  1. Department of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Waku Hatta & Tooru Shimosegawa

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan

    Takuji Gotoda

  3. Division of Endoscopy, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 385-0051, Japan

    Tsuneo Oyama & Akiko Takahashi

  4. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Noboru Kawata

  5. Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan

    Yoshikazu Yoshifuku

  6. Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Shu Hoteya

  7. Department of Internal Medicine, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan

    Koki Nakamura

  8. Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu, Niigata, 943-0192, Japan

    Masaaki Hirano

  9. Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan

    Mitsuru Esaki

  10. Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nisinagae, Toyama, Toyama, 930-8550, Japan

    Mitsuru Matsuda

  11. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 952-8501, Japan

    Ken Ohnita

  12. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan

    Ryo Shimoda

  13. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan

    Motoyuki Yoshida

  14. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan

    Osamu Dohi

  15. Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan

    Jun Takada

  16. Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Keiko Tanaka

  17. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, Kyoto, 605-0981, Japan

    Shinya Yamada

  18. Department of Gastroenterology, Akita City Hospital, 4-30 Matsuoka-machi, Kawamoto, Akita, Akita, 010-0933, Japan

    Tsuyotoshi Tsuji

  19. Department of Gastroenterology, Osaki Citizen Hospital, 3-8-1 Honami, Furukawa, Osaki, Miyagi, 989-6183, Japan

    Hirotaka Ito

  20. Division of Gastroenterology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, Fukui, 910-8526, Japan

    Yoshiaki Hayashi

  21. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan

    Tomohiro Nakamura

Authors
  1. Waku Hatta
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  2. Takuji Gotoda
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  21. Yoshiaki Hayashi
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  23. Tooru Shimosegawa
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Corresponding author

Correspondence to Waku Hatta.

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Hatta, W., Gotoda, T., Oyama, T. et al. Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multi-center retrospective study in Japan. J Gastroenterol 52, 175–184 (2017). https://doi.org/10.1007/s00535-016-1210-4

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  • DOI: https://doi.org/10.1007/s00535-016-1210-4

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