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Long-term outcomes of endoscopic resection followed by additional surgery after non-curative resection in undifferentiated-type early gastric cancer: a nationwide multi-center study

Authors
Kim, Jie-HyunKim, Young-IIAhn, Ji YongShin, Woon GeonYang, Hyo-JoonNam, Su YounMin, Byung-HoonJang, Jae-YoungLim, Joo HyunLee, Wan SikLee, Bong EunJoo, Moon KyungPark, Jae MyungLee, Hang LakGweon, Tae-GeunPark, Moo InChoi, JeongminTae, Chung HyunKim, Young-WooPark, BoramChoi, Il Ju
Issue Date
Mar-2022
Publisher
Springer Verlag
Keywords
Stomach neoplasms; Undifferentiated-type histology; Endoscopic mucosal resection; Surgery; Treatment outcome
Citation
Surgical Endoscopy, v.36, no.3, pp.1847 - 1856
Indexed
SCIE
SCOPUS
Journal Title
Surgical Endoscopy
Volume
36
Number
3
Start Page
1847
End Page
1856
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/52541
DOI
10.1007/s00464-021-08464-4
ISSN
0930-2794
Abstract
Background Undifferentiated-type early gastric cancer (UD EGC) shows lower curative resection rates after endoscopic submucosal dissection (ESD). Additional surgery is recommended after non-curative resection. We evaluated the long-term outcomes of ESD followed by additional surgery after non-curative resection in UD EGC compared to those for surgery as initial treatment. Methods We reviewed 1139 UD EGC patients who underwent ESD at 18 hospitals and 1956 patients who underwent surgery at two hospitals between February 2005 and May 2015. We enrolled 636 patients with non-curative ESD and 1429 surgery subjects beyond the curative ESD criteria. Among them, 133 patients with additional surgery after ESD (ESD + OP group) and 252 patients without additional surgery (ESD-only group) were matched 1:1 using propensity scores to patients with surgery as initial treatment (surgery group). Overall survival (OS) and recurrence-free survival (RFS) were compared. Results Signet ring cell carcinoma and poorly differentiated adenocarcinoma (PDA) were observed in 939 and 1126 cases, respectively. OS was significantly longer in the surgery group than in the ESD + OP group, especially for PDA. However, RFS was shorter in the ESD-only group than those in the ESD + OP and surgery groups. RFS did not differ significantly between the ESD + OP and surgery groups. Compared to the surgery group, the ESD-only and ESD + OP groups had an overall hazard ratio for RFS of 3.58 (95% confidence interval 1.44–8.88) and 0.46 (0.10–2.20), respectively. Conclusions ESD followed by additional surgery after non-curative resection showed comparable cancer-specific outcomes to initial surgery in UD EGC.
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Joo, Moon Kyung
Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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