Su1984 Long Term Prognosis After Non-Curative Endoscopic Submucosal Dissection for Gastric Cancer

Abstract

Objective Endoscopic Submucosal Dissection (ESD) has been accepted and established as a standard treatment for early gastric cancer (EGC) without distant metastasis. With increase of elderly population, many aged patients have chance to receive ESD for their EGC. However, some patient resulted in unsuccessful non-curative ESD, and followed-up without additional surgery by limitation of various risks of comorbid disease and low performance status or patients' refusal for additional treatment. The aim of the present study is to assess the longterm clinical outcomes of non-curative ESD with or without additional surgery and effect of additional surgery for non-curative ESD. Methods We reviewed chart data on all patients who had undergone ESD for EGC at two foundation hospitals of Saga Medical school hospital and Saga prefectural Hospital between 2001 and 2012. A total of 957 cases (1047 lesions) of EGC underwent ESD, and a total of 99 cases resulted in non-curative ESD. We excluded 20 cases because un-enough follow-up period less than 36 months. As to the target 79 cases, we divided into observation group and additional surgery group. We compared overall and disease-specific survival rate between two groups Results After unsuccessful non-curative ESD, 28 patients (35.4%) underwent additional surgery and 51 patients (64.6%) were followed without surgery. Average age of patients without additional surgery was higher than that of additional surgery group (75.8 y.o. vs. 71.6 y.o.; P=0.03). There was no significant difference in gender ratio. The incidence of complicated hypertension was significantly higher in the observation group compared to additional surgery group (49.0% vs. 25.9%; P=0.04). Incidence of other comorbid diseases, such as cardiac disease, cerebrovascular disease, chronic liver disease, chronic kidney disease, and diabetes did not differ between the two groups. There was no significant difference in pathological feature except for ulcer findings. Mean follow-up period of patients with additional surgery was 60.2 months and that of patient observation alone was 57.0 months. Overall survival rate of additional surgery group was longer than observation group. However, only one patient died from gastric cancer in the observation group. Main causes of death were their comorbid diseases. Diseasespecific survival rate was not significantly different between the two groups. Conclusions It is acceptable to follow up without additional surgery for EGD patients with comorbid disease and low performance resulted in non-curative ESD.