Risk of lymph node metastasis in early gastric cancer and indications for endoscopic resection: is it worth applying the east rules to the west?
Background Early gastric cancers are associated with lymph node metastasis (LNM) in 15% of cases. Risk factors for LNM are well established in Eastern countries. Less invasive treatments, such as endoscopic or surgical laparoscopic resection, are well accepted in Eastern countries and a matter of in...
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| Veröffentlicht in: | Surgical endoscopy 2021-08, Vol.35 (8), p.4380-4388 |
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| creator | Milhomem, Leonardo Medeiros Milhomem-Cardoso, Daniela Medeiros da Mota, Orlando Milhomem Mota, Eliane Duarte Kagan, Alan Filho, Jales Benevides Santana |
| description | Background
Early gastric cancers are associated with lymph node metastasis (LNM) in 15% of cases. Risk factors for LNM are well established in Eastern countries. Less invasive treatments, such as endoscopic or surgical laparoscopic resection, are well accepted in Eastern countries and a matter of intense debate in the West, were indications for such treatments are still contested The objective of the study is to determine risk factors related to LNM and to validate endoscopic resection indications.
Methods
The study was a retrospective cohort of 178 patients with early gastric cancer who underwent gastrectomy. Clinical and pathological factors were analyzed. The new rules of ER from JGCA were applied to the studied cohort.
Results
LNM was present in 13.48% of the cases, 3.96% (3/76) in T1a tumors and 20.58% (21/102) in T1b tumors. In univariate analysis ulceration (
p
= 0.04), differentiation grade (
p
= 0.04), submucosal invasion (
p
= 0.001), lymphatic invasion (
p
|
| doi_str_mv | 10.1007/s00464-020-07932-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2439976106</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2549110077</sourcerecordid><originalsourceid>FETCH-LOGICAL-c401t-7458b4349c85244c8fbc343dcda2062f0e959ec3cd15b8b9482965017ed9d7be3</originalsourceid><addsrcrecordid>eNp9kd2KFDEQhYMoOK6-gFcBb7xpzV93Ot6ILP7BgiB6HdJJ9UzWnqRNZVjmLXxk0zuC4IUQSKj6zqkih5DnnL3ijOnXyJgaVMcE65g2UnT6Adlx1R5C8PEh2TEjWSe0UY_JE8Rb1njD-x359TXiD5pnupyP64GmHIAeoTpsJyKNiYIry5nuW6VET71LHgp1KbReiN7VmBPSORcKKWT0eW1UAQS_dd7QzaTSu1zqgbp1Xc4x7Wk9QPPFSstpAaQ131fuAOvbp-TR7BaEZ3_uK_L9w_tv15-6my8fP1-_u-m8Yrx2WvXjpKQyfuyFUn6cJy-VDD44wQYxMzC9AS994P00TkaNwgw94xqCCXoCeUVeXnzXkn-e2mR7jOhhWVyCfEIrlDRGD5wNDX3xD3qbTyW17azo2zduCehGiQvlS0YsMNu1xKMrZ8uZ3RB7Ccm2kOx9SHYTyYsIG5z2UP5a_0f1Gz6yljQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2549110077</pqid></control><display><type>article</type><title>Risk of lymph node metastasis in early gastric cancer and indications for endoscopic resection: is it worth applying the east rules to the west?</title><source>SpringerLink Journals - AutoHoldings</source><creator>Milhomem, Leonardo Medeiros ; Milhomem-Cardoso, Daniela Medeiros ; da Mota, Orlando Milhomem ; Mota, Eliane Duarte ; Kagan, Alan ; Filho, Jales Benevides Santana</creator><creatorcontrib>Milhomem, Leonardo Medeiros ; Milhomem-Cardoso, Daniela Medeiros ; da Mota, Orlando Milhomem ; Mota, Eliane Duarte ; Kagan, Alan ; Filho, Jales Benevides Santana</creatorcontrib><description>Background
Early gastric cancers are associated with lymph node metastasis (LNM) in 15% of cases. Risk factors for LNM are well established in Eastern countries. Less invasive treatments, such as endoscopic or surgical laparoscopic resection, are well accepted in Eastern countries and a matter of intense debate in the West, were indications for such treatments are still contested The objective of the study is to determine risk factors related to LNM and to validate endoscopic resection indications.
Methods
The study was a retrospective cohort of 178 patients with early gastric cancer who underwent gastrectomy. Clinical and pathological factors were analyzed. The new rules of ER from JGCA were applied to the studied cohort.
Results
LNM was present in 13.48% of the cases, 3.96% (3/76) in T1a tumors and 20.58% (21/102) in T1b tumors. In univariate analysis ulceration (
p
= 0.04), differentiation grade (
p
= 0.04), submucosal invasion (
p
= 0.001), lymphatic invasion (
p
< 0.001), and vascular invasion (
p
< 0.001) were associated with LNM. In multivariate analysis, differentiation grade (
p
= 0.005) and submucosal invasion (
p
= 0.005) were independent risk factors. One patient classified in the expanded criteria group and seven from the relative criteria group had LNM. There were no LNM for undifferentiated mucosal lesions without ulceration.
Conclusions
Undifferentiated tumors and submucosal invasion are risks factors associated with LNM in early gastric cancer in our study. Endoscopic Resection or less invasive and radical surgical treatments are an option to be carefully considered.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-07932-7</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Endoscopy ; Gastric cancer ; Gastroenterology ; Gynecology ; Hepatology ; Lymphatic system ; Medicine ; Medicine & Public Health ; Metastasis ; Proctology ; Risk factors ; Surgery ; Tumors</subject><ispartof>Surgical endoscopy, 2021-08, Vol.35 (8), p.4380-4388</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-7458b4349c85244c8fbc343dcda2062f0e959ec3cd15b8b9482965017ed9d7be3</citedby><cites>FETCH-LOGICAL-c401t-7458b4349c85244c8fbc343dcda2062f0e959ec3cd15b8b9482965017ed9d7be3</cites><orcidid>0000-0003-1742-8620</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-07932-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-07932-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids></links><search><creatorcontrib>Milhomem, Leonardo Medeiros</creatorcontrib><creatorcontrib>Milhomem-Cardoso, Daniela Medeiros</creatorcontrib><creatorcontrib>da Mota, Orlando Milhomem</creatorcontrib><creatorcontrib>Mota, Eliane Duarte</creatorcontrib><creatorcontrib>Kagan, Alan</creatorcontrib><creatorcontrib>Filho, Jales Benevides Santana</creatorcontrib><title>Risk of lymph node metastasis in early gastric cancer and indications for endoscopic resection: is it worth applying the east rules to the west?</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><description>Background
Early gastric cancers are associated with lymph node metastasis (LNM) in 15% of cases. Risk factors for LNM are well established in Eastern countries. Less invasive treatments, such as endoscopic or surgical laparoscopic resection, are well accepted in Eastern countries and a matter of intense debate in the West, were indications for such treatments are still contested The objective of the study is to determine risk factors related to LNM and to validate endoscopic resection indications.
Methods
The study was a retrospective cohort of 178 patients with early gastric cancer who underwent gastrectomy. Clinical and pathological factors were analyzed. The new rules of ER from JGCA were applied to the studied cohort.
Results
LNM was present in 13.48% of the cases, 3.96% (3/76) in T1a tumors and 20.58% (21/102) in T1b tumors. In univariate analysis ulceration (
p
= 0.04), differentiation grade (
p
= 0.04), submucosal invasion (
p
= 0.001), lymphatic invasion (
p
< 0.001), and vascular invasion (
p
< 0.001) were associated with LNM. In multivariate analysis, differentiation grade (
p
= 0.005) and submucosal invasion (
p
= 0.005) were independent risk factors. One patient classified in the expanded criteria group and seven from the relative criteria group had LNM. There were no LNM for undifferentiated mucosal lesions without ulceration.
Conclusions
Undifferentiated tumors and submucosal invasion are risks factors associated with LNM in early gastric cancer in our study. Endoscopic Resection or less invasive and radical surgical treatments are an option to be carefully considered.</description><subject>Abdominal Surgery</subject><subject>Endoscopy</subject><subject>Gastric cancer</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Lymphatic system</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Proctology</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Tumors</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kd2KFDEQhYMoOK6-gFcBb7xpzV93Ot6ILP7BgiB6HdJJ9UzWnqRNZVjmLXxk0zuC4IUQSKj6zqkih5DnnL3ijOnXyJgaVMcE65g2UnT6Adlx1R5C8PEh2TEjWSe0UY_JE8Rb1njD-x359TXiD5pnupyP64GmHIAeoTpsJyKNiYIry5nuW6VET71LHgp1KbReiN7VmBPSORcKKWT0eW1UAQS_dd7QzaTSu1zqgbp1Xc4x7Wk9QPPFSstpAaQ131fuAOvbp-TR7BaEZ3_uK_L9w_tv15-6my8fP1-_u-m8Yrx2WvXjpKQyfuyFUn6cJy-VDD44wQYxMzC9AS994P00TkaNwgw94xqCCXoCeUVeXnzXkn-e2mR7jOhhWVyCfEIrlDRGD5wNDX3xD3qbTyW17azo2zduCehGiQvlS0YsMNu1xKMrZ8uZ3RB7Ccm2kOx9SHYTyYsIG5z2UP5a_0f1Gz6yljQ</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Milhomem, Leonardo Medeiros</creator><creator>Milhomem-Cardoso, Daniela Medeiros</creator><creator>da Mota, Orlando Milhomem</creator><creator>Mota, Eliane Duarte</creator><creator>Kagan, Alan</creator><creator>Filho, Jales Benevides Santana</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1742-8620</orcidid></search><sort><creationdate>20210801</creationdate><title>Risk of lymph node metastasis in early gastric cancer and indications for endoscopic resection: is it worth applying the east rules to the west?</title><author>Milhomem, Leonardo Medeiros ; Milhomem-Cardoso, Daniela Medeiros ; da Mota, Orlando Milhomem ; Mota, Eliane Duarte ; Kagan, Alan ; Filho, Jales Benevides Santana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-7458b4349c85244c8fbc343dcda2062f0e959ec3cd15b8b9482965017ed9d7be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Endoscopy</topic><topic>Gastric cancer</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Lymphatic system</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Proctology</topic><topic>Risk factors</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Milhomem, Leonardo Medeiros</creatorcontrib><creatorcontrib>Milhomem-Cardoso, Daniela Medeiros</creatorcontrib><creatorcontrib>da Mota, Orlando Milhomem</creatorcontrib><creatorcontrib>Mota, Eliane Duarte</creatorcontrib><creatorcontrib>Kagan, Alan</creatorcontrib><creatorcontrib>Filho, Jales Benevides Santana</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Milhomem, Leonardo Medeiros</au><au>Milhomem-Cardoso, Daniela Medeiros</au><au>da Mota, Orlando Milhomem</au><au>Mota, Eliane Duarte</au><au>Kagan, Alan</au><au>Filho, Jales Benevides Santana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of lymph node metastasis in early gastric cancer and indications for endoscopic resection: is it worth applying the east rules to the west?</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><date>2021-08-01</date><risdate>2021</risdate><volume>35</volume><issue>8</issue><spage>4380</spage><epage>4388</epage><pages>4380-4388</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Early gastric cancers are associated with lymph node metastasis (LNM) in 15% of cases. Risk factors for LNM are well established in Eastern countries. Less invasive treatments, such as endoscopic or surgical laparoscopic resection, are well accepted in Eastern countries and a matter of intense debate in the West, were indications for such treatments are still contested The objective of the study is to determine risk factors related to LNM and to validate endoscopic resection indications.
Methods
The study was a retrospective cohort of 178 patients with early gastric cancer who underwent gastrectomy. Clinical and pathological factors were analyzed. The new rules of ER from JGCA were applied to the studied cohort.
Results
LNM was present in 13.48% of the cases, 3.96% (3/76) in T1a tumors and 20.58% (21/102) in T1b tumors. In univariate analysis ulceration (
p
= 0.04), differentiation grade (
p
= 0.04), submucosal invasion (
p
= 0.001), lymphatic invasion (
p
< 0.001), and vascular invasion (
p
< 0.001) were associated with LNM. In multivariate analysis, differentiation grade (
p
= 0.005) and submucosal invasion (
p
= 0.005) were independent risk factors. One patient classified in the expanded criteria group and seven from the relative criteria group had LNM. There were no LNM for undifferentiated mucosal lesions without ulceration.
Conclusions
Undifferentiated tumors and submucosal invasion are risks factors associated with LNM in early gastric cancer in our study. Endoscopic Resection or less invasive and radical surgical treatments are an option to be carefully considered.</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s00464-020-07932-7</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-1742-8620</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2021-08, Vol.35 (8), p.4380-4388 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2439976106 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Endoscopy Gastric cancer Gastroenterology Gynecology Hepatology Lymphatic system Medicine Medicine & Public Health Metastasis Proctology Risk factors Surgery Tumors |
| title | Risk of lymph node metastasis in early gastric cancer and indications for endoscopic resection: is it worth applying the east rules to the west? |
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