Abstract
Endoscopic submucosal dissection (ESD) for early gastric cancer does not always lead to complete cancer resection. The aim of this study was to determine indicators for cancer residue (CR) status in cases of non-curative ESD. We analyzed 47 cases of non-curative ESD followed by salvage surgery and collected data regarding the rates of CR, which included both local CR and lymph node metastasis (LNM). To elucidate the risk factors for CR status, we compared the CR positive and the CR negative groups among surgical specimens according to the following variables obtained from ESD findings: tumor location, tumor size, depth of invasion, lympho-vascular invasion, histological margin, and histological diagnosis. The eCura system, which is an LNM risk scoring system, was also applied and scores were calculated in each case as follows: 3 points for lymphatic invasion and 1 point each for tumor size >30 mm, positive vertical margin, venous invasion, and submucosal invasion ≥500 μm. There were 9 (19%) CR positive cases, which included 6 cases of local CR and 4 cases of LNM; no cancer was detected in over 80% of the patients. The eCura scoring system was the only significant factor for CR status: the higher the eCura score, the greater the CR positivity (p = 0.0128). In particular, all patients in the low-risk group (score = 0–1 point) had no CR. Although no cancer recurrence was observed during a median follow-up of 4 years, 2 patients died of pneumonia. In conclusion, the eCura system might make it possible to select appropriate cases for salvage surgery.
Highlights
Gastric cancer (EGC) is defined as invasive gastric cancer that invades no deeper than the submucosa, irrespective of lymph node metastasis [1]
We investigated the rates of local cancer residue (CR) and lymph node metastasis (LNM) in patients with gastric cancer who underwent salvage gastrectomy for non-curative Endoscopic submucosal dissection (ESD) and applied the eCura scoring system to our data and explored whether it could serve as an indicator in the selection of appropriate patients for salvage surgery
Depth of tumor invasion was classified as mucosal invasion (M) in 5 cases (11%), superficial submucosal invasion (SM1) in 7 (15%), deeper submucosal invasion (SM2) in 32 (68%), muscularis propria invasion (MP) in 2 (4%), and subserosal invasion (SS) in 1 (2%)
Summary
Gastric cancer (EGC) is defined as invasive gastric cancer that invades no deeper than the submucosa, irrespective of lymph node metastasis [1]. The analysis of 47 patients with non-curative ESDs followed by salvage surgery for gastric cancer intact using connective-tissue coating [2], has been developed to become a minimally invasive and function-preserving treatment for EGC with negligible risk of lymph node metastasis (LNM) [3,4,5,6]. Because of these advantages, the indications for ESD have been expanding [6]. Clarifying the risk factors affecting CR status after non-curative ESD would be valuable to avoid unnecessary treatment such as ineffectual surgery
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