Top

Published in:

Open Access 01-12-2018 | Research article

Safety of expanded criteria for endoscopic resection of early gastric cancer in a Western cohort

Authors: Rimantas Bausys, Augustinas Bausys, Kazimieras Maneikis, Viktorija Belogorceva, Eugenijus Stratilatovas, Kestutis Strupas

Published in: BMC Surgery | Issue 1/2018

Abstract

Background

Endoscopic resection is widely accepted treatment option for early gastric cancer if tumors meet the standard or expanded indications. However, the safety of expanded criteria is still under investigation. Furthermore, discussion, if any additional treatment is necessary for patients who underwent endoscopic resection but exceeded expanded criteria, is rising. This study aimed to evaluate the safety of extended indications for endoscopic resection of early gastric cancer in a Western cohort. Also, we aimed to analyze the lymph node metastasis rate in tumors which exceeds the extended criteria.

Methods

Two hundred eighteen patients who underwent surgery for early gastric cancer at National Cancer Institute, Vilnius, Lithuania between 2005 and 2015 were identified from a prospective database. Lymph node status was examined in 197 patients who met or exceeded extended indications for endoscopic resection.

Results

Lymph node metastasis was detected in 1.7% of cancers who met extended indications and in 30.2% of cancers who exceeded expanded indications. Lymphovascular invasion and deeper tumor invasion is associated with lymph node metastasis in cancers exceeding expanded indications.

Conclusions

Expanded criteria for endoscopic resection of early gastric cancer in Western settings is not entirely safe because these tumors carry the risk of lymph node metastasis.

Bollschweiler E, Berlth F, Baltin C, Mönig S, Hölscher AH. Treatment of early gastric cancer in the Western world. World J Gastroenterol WJG. 2014;20(19):5672–8.CrossRef

Mickevicius A, Ignatavicius P, Markelis R, Parseliunas A, Butkute D, Kiudelis M, et al. Trends and results in treatment of gastric cancer over last two decades at single east European Centre: a cohort study. BMC Surg. 2014;14:98.CrossRef

Jee YS, Hwang S-H, Rao J, Park DJ, Kim H-H, Lee H-J, et al. Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese gastric Cancer association treatment guidelines. Br J Surg. 2009;96(10):1157–61.CrossRef

Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc. 2011;14(2):101–12.

Association JGC. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1):1–19.

Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc. 2007;10(1):1–11.

Min YW, Min B-H, Lee JH, Kim JJ. Endoscopic treatment for early gastric cancer. World J Gastroenterol WJG. 2014;20(16):4566–73.CrossRef

Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc. 2000;3(4):219–25.

Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc. 2009;12(3):148–52.

10.

Ishikawa S, Togashi A, Inoue M, Honda S, Nozawa F, Toyama E, et al. Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type, depth of wall invasion, and lymph node metastasis. Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc. 2007;10(1):35–8.

11.

Nagano H, Ohyama S, Fukunaga T, Hiki N, Seto Y, Yamaguchi T, et al. Two rare cases of node-positive differentiated gastric cancer despite their infiltration to sm1, their small size, and lack of lymphatic invasion into the submucosal layer. Gastric Cancer. 2008;11(1):53–8.CrossRef

12.

Fukuhara S, Yabe M, Montgomery MM, Itagaki S, Brower ST, Karpeh MS. Race/ethnicity is predictive of lymph node status in patients with early gastric cancer. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2014;18(10):1744–51.CrossRef

13.

Ikoma N, Blum M, Chiang Y-J, Estrella JS, Roy-Chowdhuri S, Fournier K, et al. Race is a risk for lymph node metastasis in patients with gastric Cancer. Ann Surg Oncol. 2017;24(4):960–5.CrossRef

14.

Green PH, O’Toole KM, Slonim D, Wang T, Weg A. Increasing incidence and excellent survival of patients with early gastric cancer: experience in a United States medical center. Am J Med. 1988;85(5):658–61.CrossRef

15.

Huang Q, Zou X. Clinicopathology of early gastric carcinoma: an update for pathologists and gastroenterologists. Gastrointest Tumors. 2017;3(3–4):115–24.PubMedPubMedCentral

16.

Peng LJ, Tian SN, Lu L, Chen H, Ouyang YY, Wu YJ. Outcome of endoscopic submucosal dissection for early gastric cancer of conventional and expanded indications: systematic review and meta-analysis. J Dig Dis. 2015;16(2):67–74.CrossRef

17.

Polkowski M, Palucki J, Wronska E, Szawlowski A, Nasierowska-Guttmejer A, Butruk E. Endosonography versus helical computed tomography for Locoregional staging of gastric Cancer. Endoscopy. 2004;36(07):617–23.CrossRef

18.

Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, 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. 2017;52(2):175–84.CrossRef

19.

Bausys R, Bausys A, Vysniauskaite I, Maneikis K, Klimas D, Luksta M, et al. Risk factors for lymph node metastasis in early gastric cancer patients: report from Eastern Europe country- Lithuania. BMC Surg. 2017;17(1):108.CrossRef

20.

Suzuki S, Gotoda T, Hatta W, Oyama T, Kawata N, Takahashi A, et al. Survival benefit of additional surgery after non-curative endoscopic submucosal dissection for early gastric Cancer: a propensity score matching analysis. Ann Surg Oncol. 2017;24(11):3353–60.CrossRef

Title: Safety of expanded criteria for endoscopic resection of early gastric cancer in a Western cohort
Authors: Rimantas Bausys
Augustinas Bausys
Kazimieras Maneikis
Viktorija Belogorceva
Eugenijus Stratilatovas
Kestutis Strupas
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Surgery / Issue 1/2018
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-018-0414-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Safety of expanded criteria for endoscopic resection of early gastric cancer in a Western cohort

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Spatial cognition in minimally invasive surgery: a systematic review

A two-stage inversion technique for total auricular reconstruction: case report and literature review

Correction to: Acute acalculous cholecystitis determining Mirizzi syndrome: case report and literature review

A systematic review on the use of topical hemostats in trauma and emergency surgery

Robotic low anterior resection plus transanal natural orifice specimen extraction in a patient with situs inversus totalis

Successful joint preservation of distal radius osteosarcoma by en bloc tumor excision and reconstruction using a tumor bearing frozen autograft: a case report