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Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection.

Authors :
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
Source :
Gut & Liver. Sep2021, Vol. 15 Issue 5, p723-731. 9p.
Publication Year :
2021

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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
19762283
Volume :
15
Issue :
5
Database :
Academic Search Index
Journal :
Gut & Liver
Publication Type :
Academic Journal
Accession number :
152481659
Full Text :
https://doi.org/10.5009/gnl20291