Long-term outcomes of undifferentiated-type early gastric cancer with positive horizontal margins after endoscopic resection

Hyo Joon Yang, Wan Sik Lee, Bong Eun Lee, Ji Yong Ahn, Jae Young Jang, Joo Hyun Lim, Su Youn Nam, Jie Hyun Kim, Byung Hoon Min, Moon Kyung Joo, Jae Myung Park, Woon Geon Shin, Hang Lak Lee, Tae Geun Gweon, Moo In Park, Jeongmin Choi, Chung Hyun Tae, Young Il Kim, Il Ju Choi

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)723-731
Number of pages9
JournalGut and Liver
Volume15
Issue number5
DOIs
StatePublished - Sep 2021

Keywords

  • Endoscopic mucosal resection
  • Lymphatic metastasis
  • Margins of excision
  • Stomach neoplasms
  • Undifferentiated-type histology

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