Long-term outcomes of undifferentiated-type early gastric cancer with positive horizontal margins after endoscopic resection
- Authors
- Yang, H.-J.; Lee, W.-S.; Lee, B.E.; Ahn, J.Y.; Jang, J.-Y.; Lim, J.H.; Nam, S.Y.; Kim, J.-H.; Min, B.-H.; Joo, M.K.; Park, J.M.; Shin, W.G.; Lee, H.L.; Gweon, T.-G.; Park, M.I.; Choi, J.; Tae, C.H.; Kim, Y.-I.; Choi, I.J.
- Issue Date
- 9월-2021
- Publisher
- Editorial Office of Gut and Liver
- Keywords
- Endoscopic mucosal resection; Lymphatic metastasis; Margins of excision; Stomach neoplasms; Undifferentiated-type histology
- Citation
- Gut and Liver, v.15, no.5, pp.723 - 731
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- Gut and Liver
- Volume
- 15
- Number
- 5
- Start Page
- 723
- End Page
- 731
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/136408
- DOI
- 10.5009/gnl20291
- ISSN
- 1976-2283
- Abstract
- Background/Aims: This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management. Methods: From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46). Results: No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality. Conclusions: UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness. © 2021 Editorial Office of Gut and Liver. All rights reserved.
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