Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic ResectionLong-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection
- Other Titles
- Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection
- Yang Hyo-Joon; Lee Wan-Sik; Lee Bong Eun; Ahn Ji Yong; Jang Jae-Young; Lim Joo Hyun; Nam Su Youn; Kim Jie-Hyun; Min Byung-Hoon; Joo Moon Kyung; Park Jae Myung; Shin Woon Geon; Lee Hang Lak; Gweon Tae-Geun; Park Moo In; Choi Jeongmin; Tae Chung Hyun; Kim Young-Il; Choi Il Ju
- Issue Date
- 거트앤리버 발행위원회
- Stomach neoplasms; Undifferentiated-type histology; Endoscopic mucosal resection; Margins of excision; Lymphatic metastasis
- Gut and Liver, v.15, no.5, pp.723 - 731
- Journal Title
- Gut and Liver
- Start Page
- End Page
- Background/Aims: This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management.
Methods: From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46).
Results: No lymph node (LN) metastasis was found in patients who underwent additional surgery.
During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment.
The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality.
Conclusions: UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.
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- 2. Clinical Science > Department of Gastroenterology and Hepatology > 1. Journal Articles
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