Gut Liver.  2021 Sep;15(5):723-731. 10.5009/gnl20291.

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

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
  • 3Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 4Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
  • 7Division of Gastroenterology, Kyungpook National University Hospital and School of Medicine, Kyungpook National University, Daegu, Korea.
  • 8Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 9Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 10Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
  • 11Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 12Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.
  • 13Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
  • 14Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
  • 15Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
  • 16Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 17Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
  • 18Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

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.

Keyword

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