Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(05): E354-E362
DOI: 10.1055/s-0043-104859
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey

Naoki Ishii
1   Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Fumio Omata
1   Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Junko Fujisaki
2   Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
,
Toshiaki Hirasawa
2   Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
,
Mitsuru Kaise
3   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Shu Hoteya
3   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Satoshi Tanabe
4   Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan
,
Kenji Ishido
4   Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan
,
Ken Ohata
5   Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Maiko Takita
5   Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Tetsuya Mine
6   Department of Gastroenterology, Tokai University School of Medicine, Kanagawa, Japan
,
Muneki Igarashi
6   Department of Gastroenterology, Tokai University School of Medicine, Kanagawa, Japan
,
Tatsuya Yoshida
7   Department of Surgery, Kudanzaka Hospital, Tokyo, Japan
,
Yuichi Takeda
8   Department of Gastroenterology, Koritsu Showa Hospital, Tokyo, Japan
,
Yohei Furumoto
9   Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
,
Kenshi Matsumoto
10   Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
Naohisa Yahagi
11   Division of Research and Development for Minimally Invasive Treatment, Cancer center, Keio University School of Medicine, Tokyo, Japan
,
Hirotaka Nakashima
12   Department of Gastroenterology, Foundation of detection of early gastric carcinoma, Tokyo, Japan
,
Tomonori Wada
13   Department of Gastroenterology, Sanraku Hospital, Tokyo, Japan
,
Tomoko Tagata
14   Department of Endoscopy, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
,
Atsushi Mitsunaga
14   Department of Endoscopy, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
› Author Affiliations
Further Information

Publication History

submitted 29 July 2016

accepted after revision 13 January 2017

Publication Date:
05 May 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Background and study aims Positive horizontal margins in resected specimens are sometimes encountered after endoscopic submucosal dissection (ESD) for early gastric cancers, and appropriate treatment strategies for these cases are not established. The aim of this study was to evaluate current empirical treatments for patients with positive horizontal or indeterminable margins after ESD.

Patients and methods We performed a multicenter survey and data from 14 hospitals were collected. The pooled proportions of positive horizontal or indeterminable margins and those of patients followed up without early intervention were calculated using a logistic-normal random-effects model. For calculating pooled estimates, subgroup analyses of high- and non-high-volume centers were conducted.

Results A total of 11,796 ESD cases were enrolled and 229 patients (2 %) had positive horizontal or indeterminable margins. Ninety-eight cases were treated within 30 days of ESD and 131 cases were followed up without early treatments. Pooled estimates of positive margins in high- and non-high-volume centers were 1 % (95 % CI: 1 % – 2 %) and 2 % (95 % CI: 1 % – 4 %), respectively, and were not heterogeneous (P = 0.191). The proportion of patients followed up without early intervention ranged from 30 % to 100 %. The pooled estimate was 68 % (95 % CI: 50 % – 83 %). The pooled estimates of high- and non-high-volume centers were 65 % (95 % CI: 38 % – 85 %) and 72 % (95 % CI: 44 % – 89 %), respectively, and were not heterogeneous (P = 0.692).

Conclusion There was insufficient consensus regarding treatment strategies used for early gastric cancer with positive horizontal or indeterminable margins after ESD. Further studies are required to establish a consensus.

 

  • References

  • 1 Ono H, Kondo H, Gotoda T. et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
    CrossrefPubMedGoogle Scholar
  • 2 Neuhaus H, Costamagna G, Deviere J. et al. Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy 2006; 38: 1016-1102
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Kakushima N, Ono H, Tanaka M. et al. Factors related to lateral margin positivity for cancer in gastric specimens of endoscopic submucosal dissection. Dig Endosc 2011; 23: 227-232
    CrossrefPubMedGoogle Scholar
  • 4 Sekiguchi M, Suzuki H, Oda I. et al. Favorable long-term outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection. Endoscopy 2013; 45: 708-713
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Sekiguchi M, Suzuki H, Oda I. et al. Risk of recurrent gastric cancer after endoscopic resection with a positive lateral margin. Endoscopy 2014; 46: 273-278
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Kim TK, Kim GH, Park do Y. et al. Risk factors for local recurrence in patients with positive lateral resection margins after endoscopic submucosal dissection for early gastric cancer. Surg Endosc 2015; 29: 2891-2898
    CrossrefPubMedGoogle Scholar
  • 7 Higashimaya M, Oka S, Tanaka S. et al. Endoscopic submucosal dissection for residual early gastric cancer after endoscopic submucosal dissection. Gastrointest Endosc 2013; 77: 298-302
    CrossrefPubMedGoogle Scholar
  • 8 Hoteya S, Iizuka T, Kikuchi D. et al. Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection. Gastric Cancer 2014; 17: 697-702
    CrossrefPubMedGoogle Scholar
  • 9 Shimamura Y, Ishii N, Nakano K. et al. Repeat endoscopic submucosal dissection for recurrent gastric cancers after endoscopic submucosal dissection. World J Gastrointest Endosc 2013; 5: 600-604
    CrossrefPubMedGoogle Scholar
  • 10 The Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010. (ver. 3). Gastric Cancer 2011; 14: 113-123
    CrossrefPubMedGoogle Scholar
  • 11 Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health 2014; 72: 39
    CrossrefPubMedGoogle Scholar