Additional Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer Patients with Comorbidities

Naohiko Koide,Satoshi Ishizone,Daisuke Takeuchi,Akira Suzuki,Shinichi Miyagawa

doi:10.1155/2012/379210

Naohiko Koide, Satoshi Ishizone + Show 3 more

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https://doi.org/10.1155/2012/379210

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Abstract

Purpose. We investigated the clinicopathologic features of early gastric cancer (EGC) patients who have undergone additional gastrectomy after endoscopic submucosal dissection (ESD) because of their comorbidities. Methods. Eighteen (7.1%) of 252 GC patients were gastrectomized after prior ESD. Reasons for further surgery, preoperative and postoperative problems, and the clinical outcome were determined. Results. The 18 patients had submucosal EGC and several co-morbidities. Other primary cancers were observed in 8 (44.4%). Histories of major abdominal operations were observed in 6 (33.3%). Fourteen patients (77.8%) hoped for endoscopic treatment. Due to additional gastrectomy, residual cancer was suspected in 10, and node metastasis was suspected in 11. A cancer remnant was histologically observed in one. Node metastasis was detected in 3 (16.7%). Small EGC was newly detected in 4. Consequently, additional gastrectomy was necessary for the one third. No patient showed GC recurrence. However, 9 (50%) had new diseases, and 4 (22.2%) died of other diseases. The overall survival after surgery in these patients with additional gastrectomy was poorer than those with routine gastrectomy for submucosal EGC (P = 0.0087). Conclusions. Additional gastrectomy was safely performed in EGC patients with co-morbidities. However, some issues, including presence of node metastasis and other death after surgery, remain.

Highlights

Endoscopic treatments, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for early gastric cancer (EGC) have markedly progressed and are widely accepted [1,2,3]
From the findings of the three cases with node metastasis detected after additional gastrectomy, we suggested that additional gastrectomy should be performed in EGC patients with co-morbidity showing over 25 mm in tumor size, sm2invasion, and lymphatic invasion
Additional gastrectomy may be recommended in one third, and we should consider several issues, including surgical problems as well as the complete resection of cancer and node metastasis before/after additional gastrectomy

Summary

Introduction

Endoscopic treatments, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for early gastric cancer (EGC) have markedly progressed and are widely accepted [1,2,3]. There are cases that underwent additional gastrectomy after EMR/ESD, because cancer invades the submucosal layer of the stomach with/without lymphovascular invasion histopathologically detected in specimens obtained by EMR/ESD. There have recently been reports regarding additional treatments, including gastrectomy, after incomplete EMR/ESD [12, 13]. The clinicopathologic issues, excluding the histopathologic features of gastric cancer, in gastrectomized patients after prior ESD have not yet been investigated. We retrospectively investigated the clinicopathologic issues concerning gastrectomized patients after ESD for EGC, and the reasons for ESD and further surgery for EGC, and pre- and postoperative problems were determined from a surgical viewpoint

Patients and Methods

Problems before Treatments

Reason for Treatment of EGC

Discussion

Conclusion