Dissection For Early Gastric Cancer Research Articles

Preliminary results of multicenter questionnaire study on long‐term outcomes of curative endoscopic submucosal dissection for early gastric cancer

There are a number of published reports on long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), but most reports are from single centers with median follow-up periods shorter than 5 years. This questionnaire study investigated long-term outcomes of curative ESD for EGC at six Japanese institutions with follow-up rates of at least 90% over a minimum 5-year period. All consecutive patients with initial-onset EGC who underwent ESD through December 2006 at the six institutions were included in our study. The questionnaire covered pathological curability and long-term outcomes of patients with curative resections or curative resections for expanded indications over follow-up periods of at least 5 years. There were 3788 patients with initial-onset EGC including 1710 (45.1%) patients with curative resections and 1289 (34.0%) patients with curative resections for expanded indications. The remaining 789 (20.8%) patients had non-curativeresections. Altogether, 1601 (93.6%) patients with curative resections and 1205 (93.5%) patients with curative resections for expanded indications were successfully followed up for at least 5 years. No recurrences were reported in any of the 1601 patients with curative resections whereas three recurrences (0.2%) were reported in the 1205 patients with curative resections for expanded indications. Gastric cancer-related deaths occurred in seven (0.2%) of the 2806 patients with curative resections or curative resections for expanded indications including six patients with metachronous gastric cancer-related deaths. This questionnaire study's results indicated favorable long-term outcomes for patients with curative resections or curative resections for expanded indications.

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience

In Korea, endoscopic submucosal dissection (ESD) has been widely accepted for the treatment of early gastric cancers (EGCs). However, the understanding of the long-term clinical outcome of ESD for EGC remains insufficient. Therefore, the aim of the present study was to assess the long-term clinical outcome and efficacy of ESD for the treatment of EGCs, including the clinical application of the expanded criteria for ESD. From January 2006 to December 2010, a total of 515 patients with 522 EGCs were treated by ESD in our hospital; study enrollment was based on the expanded criteria. Comparisons of resectability (en bloc or piecemeal resection), curability (curative or non-curative), and complications (bleeding and perforation) between the standard and expanded groups were assessed. Thereafter, 336 patients with 342 EGCs were finally included in a long-term analysis of local tumor recurrence, development of synchronous and metachronous cancers, and overall and disease-specific survival rates. En bloc and curative resection rates of 96.7 % and 88.3 %, respectively, were achieved. The curative resection rate was significantly lower in the expanded group than in the standard group (82.1 % vs. 91.5 %, p = 0.001). During a median follow-up of 24 months, the local tumor recurrence rate was also higher in the expanded group than in the standard group (7.0 % vs. 1.8 %, p = 0.025). Local recurrence was more frequent in lesions with non-curative resection than in those with curative resection (20.0 % vs. 1.3 %, p < 0.001). The 5-year overall and disease-specific survival rates were 88 % and 100 %, respectively; the difference between the standard and expanded groups was not significant (p = 0.834). ESD appears to be a feasible and effective method for treating EGCs, based on the standard and expanded criteria. Close follow-up surveillance, after ESD, should be standard for all patients.

The role of second-look endoscopy in endoscopic submucosal dissection for early gastric cancer

Delayed bleeding is a major complication of endoscopic submucosal dissection. Second-look endoscopy is routinely performed in most hospitals to reduce the possibility of delayed bleeding without solid evidence to support this practice. The aim of this study was to evaluate whether second-look endoscopy prevents delayed bleeding, and to verify clinicopathological features of delayed bleeding in order to identify lesions that may benefit from a second-look endoscopy. We investigated 392 lesions in 388 patients who underwent endoscopic submucosal dissection for early gastric cancer from January 2006 to July 2011. Clinically evident bleeding from mucosal defects 24 hours after endoscopic submucosal dissection was considered delayed bleeding. Data including characteristics of patients, lesions, and procedures were reviewed. Furthermore, the rate of delayed bleeding before and after second-look endoscopy, performed within three days of endoscopic submucosal dissection, was investigated to determine the utility of second-look endoscopy. Delayed bleeding was evident in 12 of 392 lesions (3,1%), all of which achieved endoscopic hemostasis. The only significant factor predicting delayed bleeding was a resected specimen size of over 40 mm (OR=6,200, 95% CI=1,912 - 20,108). Delayed bleeding occurred more frequently prior to the second-look endoscopy (p=0,022). In our endoscopic submucosal dissection data about early gastric cancer, it is too early to conclude that second-look endoscopy is not a valuable procedure, and second-look endoscopy may be useful for preventing post-endoscopic submucosal dissection bleeding, especially in resected specimens greater than 40 mm in size.

Endoscopic Submucosal Dissection of Early Gastric Cancer Using the Insulated Tip Knife

Endoscopic submucosal dissection (ESD) is an endoscopic technique in which a gastrointestinal mucosal neoplasm can be excised by cutting through the submucosa with an endoscopic knife. It can be used with diagnostic or therapeutic intent and allows en bloc removal of the specimen. ESD usually begins with identification and evaluation of the lesion and assessment of the margin with chromo-endoscopy. The subsequent steps include marking, submucosal injection, and circumferential and submucosal dissection. Complications should be promptly recognized and dealt with immediately if necessary.This video demonstrates the main steps of the technique and management of complications. This article is part of an expert video encyclopedia.

Tu1289 Continued Use of Low Dose Aspirin Dose Not Increase the Risk of Bleeding During or After Endoscopic Submucosal Dissection for Early Gastric Cancer

Tu1289 Continued Use of Low Dose Aspirin Dose Not Increase the Risk of Bleeding During or After Endoscopic Submucosal Dissection for Early Gastric Cancer

Sa1572 Clinicopathological Factors of Multiple Lateral Margin Involvement in Endoscopic Submucosal Dissection for Early Gastric Cancer

Background and study aims In some ESD specimens of EGC, tumors involve multiple lateral margins. However, the factors related to the number of lateral margins involved are unclear. We evaluated the factors related to the multiplicity of lateral margin involvement in specimens of ESD for EGC.

Sa1570 Factors Associated With Incomplete Endoscopic Submucosal Dissection for Early Gastric Cancer

Endoscopic submucosal dissection (ESD) is widely accepted for treating early gastric cancer (EGC), but there still are cases of incomplete resection.

Tu1291 Serum C-Reactive Protein As a Possible Marker to Predict Delayed Bleeding After Endoscopic Submucosal Dissection for Early Gastric Cancer

Endoscopic submucosal dissection (ESD) has become promising procedure as a therapeutic tool for early gastric cancer (EGC). However, delayed bleeding occurs occasionally and it sometimes leads to severe hemorrhage or shock. There has been no useful indicator to predict the risk of bleeding after ESD for EGC. We focused on C-reactive protein (CRP) which has been reported to be a possible marker to predict bleeding after colon polypectomy. The aim of this study is to clarify the usefulness of serum CRP levels for the prediction of delayed bleeding after ESD for EGC.

Sa1486 Long-Term Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer: a Single Center Experience

Endoscopic submucosal dissection (ESD) has been widely accepted for treatment of early gastric cancer (EGC) in Korea. But long-term clinical outcomes of ESD for EGC remain unknown. The aim of the present study was to evaluate tumor recurrence and survival after ESD.

Sa1568 Long-Term Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer: a Historical Comparison Versus Endoscopic Mucosal Resection in a Single Center

Sa1568 Long-Term Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer: a Historical Comparison Versus Endoscopic Mucosal Resection in a Single Center

Su1543 Effectiveness of Endoscopic Ultrasonography for Therapeutic Decision Making for Endoscopic Submucosal Dissection in Early Gastric Cancer

Su1543 Effectiveness of Endoscopic Ultrasonography for Therapeutic Decision Making for Endoscopic Submucosal Dissection in Early Gastric Cancer

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

Few studies have compared the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in patients with early gastric cancer. We studied 780 lesions for which endoscopic treatment was indicated according to the Japanese Gastric Cancer Association (JGCA) criteria or the extended National Cancer Center (NCC) criteria from April 1995 to December 2007. A total of 359 lesions were treated by endoscopic aspiration mucosectomy (EAM) between April 1995 and March 2003 (EAM group), and 421 lesions were treated by ESD between April 2003 and December 2007 (ESD group). Long-term outcomes (local recurrence rate, overall survival) were compared between the groups. The median follow-up was 73 months in the EAM group and 65 months in the ESD group. Overall, the local recurrence rate was significantly lower in the ESD group (0.2 %, 1/421) than in the EAM group (4.2 %, 15/359) (p < 0.05). For lesions meeting the JGCA criteria, the local recurrence rate was 2.9 % in the EAM group and 0 % in the ESD group (p < 0.05). For lesions meeting the NCC criteria, the local recurrence rate was 12.5 % in the EAM group and 0.6 % in the ESD group (p < 0.05). There was no significant difference between the groups in overall survival. On long-term follow-up, ESD was associated with a lower rate of local recurrence than EAM for lesions that met the JGCA or the NCC criteria. From the point of view of radical curability, ESD can be recommended for the management of lesions that meet either set of criteria.

Long‐term outcomes of endoscopic submucosal dissection for early gastric cancer: A single‐center retrospective study

The aim of the present study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) based on the long-term outcomes. From June 2002 to March 2007, ESD was carried out in 472 cases and 570 lesions of EGC. Post-surgical cases and status-unknown cases were excluded. The following long-term outcomes were examined in 438 patients who were reliably followed up for at least 5 years after treatment (range: 5 years [60 months] to 9 years, 9 months [117 months]): local recurrence, metachronous recurrences, and the survival rate. The overall en bloc resection rate was 97.7% for all lesions treated by ESD. The median procedure time was 47.0 min (range 8-345 min). The incidence of positive horizontal andvertical margins was 3.7% and 3.4%, respectively. The incidence of perforation and postoperative bleeding was 5.3% and 4.3%, respectively. There were no deaths related to ESD. Local recurrence was observed in five patients (1.1%), and metachronous recurrences in 7.8% of the patients. The post-treatment 5-year survival was 83.1%. There were no deaths as a result of gastric cancer associated with sites treated by ESD. ESD can be considered a standard treatment for EGC based on its expanded indications and low incidences of local recurrence and lymph node metastasis.

Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy

Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) after surgical gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach as well as the presence of severe gastric fibrosis and staples under the suture line. We evaluated clinical results including long-term outcomes to determine the feasibility and effectiveness of ESD for EGC in the remnant stomach of patients after gastrectomy. Retrospective study. National Cancer Center Hospital, Tokyo, Japan. We investigated patients undergoing ESD for EGC in the remnant stomach from 1997 to 2011. We examined the patient characteristics, endoscopic findings, technical results, adverse events, and histopathologic results including curability and evaluations of Helicobacter pylori gastritis in addition to the rates of local recurrence, metachronous gastric cancer, overall survival, and cause-specific survival. A total of 128 consecutive patients with 139 lesions had previously undergone 87 distal (68%), 25 proximal (19.5%) and 16 pylorus-preserving gastrectomies (12.5%). The median period from the original gastrectomy to the subsequent ESD for EGC in the remnant stomach was 5.7 years (range 0.6-51 years), the median tumor size was 13 mm (range 1-60 mm), and the median procedure time was 60 minutes (range 15-310 minutes). There were 131 en bloc resections (94%), with curative resections achieved for 109 lesions (78%); 22 lesions (16%) resulted in non-curative resections, and 8 lesions (6%) had only a horizontal margin positive or had inconclusive results. A total of 118 patients (92%) were assessed as H pylori gastritis-positive, with 7 patients (5%) negative. Adverse events included 2 cases of delayed bleeding (1.4%) and 2 perforations (1.4%), with 1 patient requiring emergency surgery. The 5-year overall and cause-specific survival rates were 87.3% and 100%, respectively, during a median follow-up period of 4.5 years (range 0-13.7 years), with no deaths from EGC in the remnant stomach. Single-center, retrospective study. ESD for EGC in the remnant stomach of patients after gastrectomy was a feasible and effective therapeutic method and should become the standard treatment in such cases, based on the favorable long-term outcomes.

Development and clinical usability of a new traction device “medical ring” for endoscopic submucosal dissection of early gastric cancer

BackgroundAlthough various traction devices exist for endoscopic submucosal dissection (ESD), the effects of the material used in the devices on the human body has not been considered. Moreover, there has been no report on a device that facilitates dissection both on the oral and anal side of the lesion. We made a traction device that has no deleterious effects on the body and is noninvasive, easy to use, and enables a bilateral approach in ESD. We report the process of its creation and a prospective evaluation of its usage in actual ESD procedures.MethodsThis study is prospective case control study. Thirty-seven patients for whom the device would be used were consecutively and prospectively enrolled (device used group). Control subjects in whom the device would not be used and who had lesions matched for size and location with those of the device used group were randomly selected (device not used group). Both groups were classified into three subgroups according to treatment difficulty: group A: easy; group B: intermediate; and group C: difficult. The dissection time per cm2 in each group was examined.ResultsDissection times in the device not used group/device used group were as follows: group A, 5.8/2.1 min/cm2 (p < 0.01); group B, 6.1/3.8 min/cm2 (p < 0.05); and group C, 7.9/3.6 min/cm2 (p < 0.01), respectively.ConclusionsThe newly developed medical ring was shown to be feasible and safe and allowed excellent visualization through suitable tension and facilitated rapid gastric ESD.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-013-2887-6) contains supplementary material, which is available to authorized users.

Long-term outcome of early gastric cancer after endoscopic submucosal dissection: Expanded indication is comparable to absolute indication

Endoscopic submucosal dissection has become widely used for early gastric cancer with an expanded indication, although there is no strong consensus. We aimed to compare the clinical and long-term oncological outcome after endoscopic submucosal dissection according to indication. Retrospective review of 1152 patients with 1175 lesions who had undergone endoscopic submucosal dissection for early gastric cancer at tertiary educational hospital in Korea, between March 2005 and November 2011. Of these, 366 and 565 lesions were included in the absolute and expanded indication groups, respectively. En bloc resection rates were not significantly different between the absolute and expanded indication groups. The complete resection rate was higher in the absolute indication group versus the expanded indication group (94.8% vs. 89.9%, respectively; P=0.008). In the expanded indication group, complete resection rate was higher in the differentiated versus undifferentiated tumour subgroups (92.9% vs. 78.4%, respectively; P<0.001). Recurrence rates were 7.7% in the absolute indication group vs. 9.3% in the expanded indication group (P=0.524). Disease-free survival was not significantly different between the two indication groups (P=0.634). Endoscopic submucosal dissection for early gastric cancer with expanded indication is a feasible approach to disease management. Periodic endoscopic follow-up is necessary to detect cancer recurrence.

How Can We Predict the Presence of Missed Synchronous Lesions After Endoscopic Submucosal Dissection for Early Gastric Cancers or Gastric Adenomas?

To identify predictive factors associated with the presence of missed synchronous lesions after endoscopic submucosal dissection (ESD) for gastric adenoma or early gastric cancer (EGC). Secondary gastric neoplasms that develop during follow-up period after ESD for gastric adenoma or EGC are divided into metachronous lesions and missed synchronous lesions. ESD was performed in 250 patients with EGC or gastric adenoma. The patients with endoscopic follow-ups of <1 year, patients without curative resection, and patients with additional surgery were excluded from the study. Missed synchronous lesions were defined as secondary gastric neoplasms detected within one year of ESD but initially missed. We compared clinicopathologic factors between patients with missed synchronous lesions and patients without missed synchronous lesions. Missed synchronous lesions were found in 11.6% of the patients (29/250). The occurrence of missed synchronous lesions had significant correlation with tumor number at the time of ESD and age in the univariate analysis. Tumor number at the time of ESD and age were significant independent predictive factors for presence of missed synchronous lesions by multivariate logistic regression analysis (odds ratio 5.302, P = 0.006; odds ratio 2.315, P = 0.040, respectively). Missed synchronous lesions tended to be smaller, often located in the same third of the stomach as the main lesions. Tumor number at the time of ESD and age could be predictive factors for the presence of missed synchronous lesions after ESD. Careful endoscopic surveillance should be performed after ESD for multiple lesions or for elderly patients.

Translumenal Single-Incision Laparoscopy Radical Gastrectomy with D2 Lymph Node Dissection for Early Gastric Cancer—Primary Experience with Less Invasive Surgery in China

In this article we report our initial clinical experience about umbilical single-incision laparoscopic surgery (SILS) radical gastrectomy with D2 lymph node dissection for early gastric cancer with conventional laparoscopic instruments. Preliminary experiences with umbilical SILS radical gastrectomy in 4 patients with early gastric cancer were described. Umbilical SILS radical gastrectomy with D2 lymph node dissection was performed successfully with conventional laparoscopic instruments in these 4 patients. Average operative time was 280 minutes, and average blood loss was 162 mL. No intraoperative or postoperative complications, such as secondary hemorrhage, anastomotic leakage, or obstruction, were recorded. The patients recovered fully, and the single umbilical scar was well healed. Our initial experience showed that transumbilical SILS radical gastrectomy with D2 lymph node dissection for early gastric cancer is feasible and safe when performed by experienced laparoscopic surgeons.

Clinical Impact of Endoscopic Submucosal Dissection for Early Gastric Cancer

Aim: The aim of this study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer based on approximately 10 years’ experience. Methods: Endoscopic submucosal dissection was performed in 1272 patients with early gastric cancer (1657 lesions). We examined en bloc resection rate, curative resection rate, local recurrence rate, procedure time, and complications. Results: The overall en bloc resection rate was 98.6% for all lesions treated by ESD. The median procedure time of the operation was 54.3 minutes (range 5 - 632 min). The incidence of positive horizontal and vertical margins was 3.8% and 4.0%, respectively. The incidence was 2.5% each for perforation and postoperative bleeding. There were no deaths related to ESD. Local recurrence was observed in 10 lesions (0.06%). Conclusion: Since the procedure time and incidence of complications have been reduced, endoscopic submucosal dissection has been considered a standard treatment for early gastric cancer.

Chylorrhea following laparoscopy assisted distal gastrectomy with D1+ dissection for early gastric cancer: A case report

INTRODUCTIONChylorrhea is a form of lymphorrhea involving digested lipid products absorbed in the small intestine. Here we report a rare case of chylorrhea after laparoscopy-assisted distal gastrectomy (LADG) with D1+ dissection that resolved following administration of a low-fat diet. PRESENTATION OF CASEA 35-year-old woman with early gastric cancer underwent LADG with D1+ dissection, and on postoperative day 4, the drain output increased and the fluid with a high triglyceride level (740mg/dL) changed from clear to milky. On postoperative day 6, oral intake of a low-fat diet was initiated after a 2-day fast, and the daily drain output decreased from postoperative day 9. The drain tube was withdrawn on postoperative day 15, and the patient was discharged on postoperative day 17. DISCUSSIOND1+ dissection does not typically cause injury to the lymphatic trunks, cisterna chyli, or thoracic duct. The maximum output of chylous ascites was minimal, and thus, we assumed that chylorrhea occurred from slightly injured lymphatics with anatomical variation. CONCLUSIONChylorrhea after LADG with D1+ dissection is very rare. The fasting of our case followed by a low-fat diet without TPN would be an effective therapy. As a result, our case recovered favorably without further therapy.