Risks and benefits of additional surgery for early gastric cancer in the upper third of the stomach meeting non-curative resection criteria after endoscopic submucosal dissection.
Additional gastrectomy
Lymph node metastasis
Non-curative endoscopic resection
Proximal gastric cancer
Journal
World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544
Informations de publication
Date de publication:
26 Sep 2022
26 Sep 2022
Historique:
received:
10
06
2022
accepted:
07
09
2022
entrez:
26
9
2022
pubmed:
27
9
2022
medline:
28
9
2022
Statut:
epublish
Résumé
Additional surgery is recommended after non-curative endoscopic submucosal dissection for early gastric cancer. However, it is not easy to recommend for tumors located in the upper third of the stomach, because it would be a total or proximal gastrectomy. This study aimed to evaluate the actual risks and benefits of additional gastrectomy for upper third tumors. We reviewed the clinicopathological data of patients who underwent total or proximal gastrectomy for early gastric cancer in the upper third of the stomach between March 2002 and January 2021. The incidence of lymph node metastasis and postoperative complications were calculated, and risk factors for lymph node metastasis were identified using logistic regression analysis. Survival rates were analyzed using the Kaplan-Meier method and log-rank test. A total of 523 patients underwent total or proximal gastrectomy for early gastric cancer; 379 of them had tumors meeting the non-curative resection criteria for endoscopic submucosal dissection. The overall lymph node metastasis rate was 9.5%, and lymphovascular invasion was the only significant risk factor for lymph node metastasis (p < 0.001). The most common sites of lymph node metastasis were stations 1, 3, and 7, with their rates being 3.2%, 3.7%, and 3.2%, respectively. Overall and severe (Clavien-Dindo grade III or higher) postoperative complication rates were 21.1% and 14.0%, respectively, while postoperative mortality was 0.5% (2/379). The 5-year overall survival rates for patients with and without lymph node metastasis were 96.1% and 81.1%, respectively (p = 0.076). Before planning an additional gastrectomy after non-curative endoscopic resection for the upper third tumor, we should consider both the benefit of the 9.5% curability for lymph node metastasis and the risks of the 21% postoperative complications and 0.5% mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Additional surgery is recommended after non-curative endoscopic submucosal dissection for early gastric cancer. However, it is not easy to recommend for tumors located in the upper third of the stomach, because it would be a total or proximal gastrectomy. This study aimed to evaluate the actual risks and benefits of additional gastrectomy for upper third tumors.
METHODS
METHODS
We reviewed the clinicopathological data of patients who underwent total or proximal gastrectomy for early gastric cancer in the upper third of the stomach between March 2002 and January 2021. The incidence of lymph node metastasis and postoperative complications were calculated, and risk factors for lymph node metastasis were identified using logistic regression analysis. Survival rates were analyzed using the Kaplan-Meier method and log-rank test.
RESULTS
RESULTS
A total of 523 patients underwent total or proximal gastrectomy for early gastric cancer; 379 of them had tumors meeting the non-curative resection criteria for endoscopic submucosal dissection. The overall lymph node metastasis rate was 9.5%, and lymphovascular invasion was the only significant risk factor for lymph node metastasis (p < 0.001). The most common sites of lymph node metastasis were stations 1, 3, and 7, with their rates being 3.2%, 3.7%, and 3.2%, respectively. Overall and severe (Clavien-Dindo grade III or higher) postoperative complication rates were 21.1% and 14.0%, respectively, while postoperative mortality was 0.5% (2/379). The 5-year overall survival rates for patients with and without lymph node metastasis were 96.1% and 81.1%, respectively (p = 0.076).
CONCLUSIONS
CONCLUSIONS
Before planning an additional gastrectomy after non-curative endoscopic resection for the upper third tumor, we should consider both the benefit of the 9.5% curability for lymph node metastasis and the risks of the 21% postoperative complications and 0.5% mortality.
Identifiants
pubmed: 36155115
doi: 10.1186/s12957-022-02780-2
pii: 10.1186/s12957-022-02780-2
pmc: PMC9511772
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
311Subventions
Organisme : National Cancer Center
ID : 2010150
Pays : Republic of Korea
Informations de copyright
© 2022. The Author(s).
Références
Gastric Cancer. 2011 Oct;14(4):301-16
pubmed: 21894577
Surg Today. 2019 Jun;49(6):529-535
pubmed: 30684050
J Surg Oncol. 2009 Oct 1;100(5):392-5
pubmed: 19598150
World J Gastroenterol. 2011 Aug 7;17(29):3390-7
pubmed: 21876631
Surg Endosc. 2015 Nov;29(11):3196-204
pubmed: 25582964
Korean J Intern Med. 2019 Jul;34(4):785-793
pubmed: 29921044
Medicine (Baltimore). 2019 May;98(19):e15663
pubmed: 31083268
World J Gastroenterol. 2017 Jul 14;23(26):4823-4830
pubmed: 28765704
Gastric Cancer. 2017 Jan;20(1):1-19
pubmed: 27342689
Gastric Cancer. 2011 Jun;14(2):101-12
pubmed: 21573743
Gastric Cancer. 2019 Sep;22(5):1060-1068
pubmed: 30830641
J Gastric Cancer. 2019 Mar;19(1):1-48
pubmed: 30944757
Int J Surg. 2018 May;53:163-170
pubmed: 29602012
Surg Endosc. 2015 Jul;29(7):1842-9
pubmed: 25294549
Br J Surg. 2015 Oct;102(11):1394-401
pubmed: 26313295
J Gastric Cancer. 2021 Sep;21(3):221-235
pubmed: 34691807
Dig Surg. 2021;38(1):1-13
pubmed: 33152740
Gastric Cancer. 2019 Jul;22(4):881-891
pubmed: 30778800
Gastric Cancer. 2018 Sep;21(5):845-852
pubmed: 29423892
Eur J Surg Oncol. 2017 Jul;43(7):1337-1343
pubmed: 28222970
Ann Surg. 2013 Dec;258(6):970-5
pubmed: 24096753
Ann Surg. 2013 Dec;258(6):964-9
pubmed: 23324857
Surg Endosc. 2013 Sep;27(9):3247-53
pubmed: 23508816
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Feb 25;21(2):168-174
pubmed: 29492915
Curr Opin Gastroenterol. 2017 Sep;33(5):315-319
pubmed: 28704212
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Surg Endosc. 2018 May;32(5):2255-2262
pubmed: 29098430
Surg Endosc. 2017 Apr;31(4):1607-1616
pubmed: 27495338
J Gastrointest Surg. 2014 Jul;18(7):1269-77
pubmed: 24820136
Surg Endosc. 2015 May;29(5):1145-55
pubmed: 25171882