Predictive factors of residual tumor for the patients with non-curative resection after endoscopic submucosal dissection for early gastric cancer.

Authors

null

Hideki Sunagawa

Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan

Hideki Sunagawa , Takahiro Kinoshita , Akio Kaito , Kazuhiro Kaneko

Organizations

Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan, Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan

Research Funding

Other

Background: Endoscopic submucosal dissection (ESD) is commonly performed for the patients who diagnosed with early gastric cancer. Although additional gastrectomy is recommended for the patients with non-curative ESD in the points of potential risk of residual tumor, many cases have neither lymph node (LN) metastasis nor local residual tumor in surgical specimens. Clinically, it can be difficult to decide whether to perform additional surgery according to patients’ conditions. This study aimed to analyze the clinicopathological features of patients who underwent additional gastrectomy as well as to detect the predictive factors for residual tumor after non-curative ESD. Methods: The patients who underwent additional gastrectomy after non-curative ESD in our institution from January 2005 to August 2016 were retrospectively reviewed. The incidence rates of LN metastasis or local residual tumor were calculated, and furthermore the predictive factors for these outcomes were estimated. Results: 211 patients were enrolled in this study. Pathological examination after additional surgery revealed LN metastasis in 18 patients (8.5%) and local residual tumor in 26 patients (12.3%). Multivariable analysis revealed that lymphatic invasion (p< 0.0001, odds ratio = 15.6), vascular invasion (p= 0.042, odds ratio = 3.92) and macroscopic findings (flat/elevated type) (p= 0.03, odds ratio = 3.53) are predictors for lymph node metastasis. All of the patients without LN metastasis revealed no lymphovascular invasion. Positive vertical margin (p= 0.0045, odds ratio = 4.17) and horizontal margin (p= 0.0002, odds ratio = 6.6) were predictors for local residual tumor. Conclusions: The risk of residual tumor can be estimated based on histopathology of ESD. Patients without lymphovascular invasion appear to be a low risk subpopulation for LN metastasis.

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Abstract Details

Meeting

2017 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cancers of the Esophagus and Stomach

Track

Cancers of the Esophagus and Stomach

Sub Track

Prevention, Diagnosis, and Screening

Citation

J Clin Oncol 35, 2017 (suppl 4S; abstract 32)

DOI

10.1200/JCO.2017.35.4_suppl.32

Abstract #

32

Poster Bd #

E10

Abstract Disclosures

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