Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer

Background. Patients with early gastric cancer undergoing noncurative endoscopic submucosal dissection (ESD) have a risk of tumor recurrence and metastasis, and some patients need additional surgery. The purpose of this study was to explore the risk factors of cancer residue and lymph node (LN) meta...

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Veröffentlicht in:Canadian Journal of Gastroenterology and Hepatology 2022, Vol.2022, p.1-7
Hauptverfasser: Duan, Kaipeng, Li, Dongbao, Shi, Dongtao, Pei, Jie, Ren, Jiayu, Li, Weikang, Dong, Anqi, Chen, Tao, Zhou, Jin
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container_title Canadian Journal of Gastroenterology and Hepatology
container_volume 2022
creator Duan, Kaipeng
Li, Dongbao
Shi, Dongtao
Pei, Jie
Ren, Jiayu
Li, Weikang
Dong, Anqi
Chen, Tao
Zhou, Jin
description Background. Patients with early gastric cancer undergoing noncurative endoscopic submucosal dissection (ESD) have a risk of tumor recurrence and metastasis, and some patients need additional surgery. The purpose of this study was to explore the risk factors of cancer residue and lymph node (LN) metastasis after noncurative ESD for early gastric cancer and to compare the short outcome of early and delayed additional surgery. Methods. The clinicopathological characteristics of 30 early gastric cancer patients who received noncurative ESD and additional surgery were studied retrospectively. Multivariable regression was utilized to examine the independent risk factors for residual cancer and LN metastasis. Receiver operating characteristic curve was used to analyze the multivariable model’s predictive performance. Furthermore, the perioperative safety and radical tumor performance of early surgery (≤30 days, n = 11), delayed surgery (>30 days, n = 11) after ESD, and upfront surgery (n = 59) were compared. Results. Multivariable regression showed that diffuse type of Lauren classification, submucosal invasion, and positive human epidermal growth factor receptor-2 (HER-2) were risk factors for residual cancer. Undifferentiated carcinoma, vascular invasion, and positive vertical margin were risk factors for LN metastasis. The area under the curve (AUC) of the multifactor model predicting cancer residue and LN metastasis was 0.761 and 0.792, respectively. The early surgery group experienced higher intraoperative blood loss and a longer operation time than the delayed surgery and upfront surgery groups. There was no significant difference in the number of LN dissections, LN metastasis rate, and postoperative complications among the three groups. Conclusion. Diffuse type of Lauren classification, submucosal invasion, and positive HER-2 are risk factors for residual cancer, while undifferentiated carcinoma, vascular invasion, and positive vertical margin are risk factors for LN metastasis. Delayed additional surgery after ESD (>30 days) has higher intraoperative safety, without affecting the radical resection in early gastric cancer patients.
doi_str_mv 10.1155/2022/3421078
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Patients with early gastric cancer undergoing noncurative endoscopic submucosal dissection (ESD) have a risk of tumor recurrence and metastasis, and some patients need additional surgery. The purpose of this study was to explore the risk factors of cancer residue and lymph node (LN) metastasis after noncurative ESD for early gastric cancer and to compare the short outcome of early and delayed additional surgery. Methods. The clinicopathological characteristics of 30 early gastric cancer patients who received noncurative ESD and additional surgery were studied retrospectively. Multivariable regression was utilized to examine the independent risk factors for residual cancer and LN metastasis. Receiver operating characteristic curve was used to analyze the multivariable model’s predictive performance. Furthermore, the perioperative safety and radical tumor performance of early surgery (≤30 days, n = 11), delayed surgery (&gt;30 days, n = 11) after ESD, and upfront surgery (n = 59) were compared. Results. Multivariable regression showed that diffuse type of Lauren classification, submucosal invasion, and positive human epidermal growth factor receptor-2 (HER-2) were risk factors for residual cancer. Undifferentiated carcinoma, vascular invasion, and positive vertical margin were risk factors for LN metastasis. The area under the curve (AUC) of the multifactor model predicting cancer residue and LN metastasis was 0.761 and 0.792, respectively. The early surgery group experienced higher intraoperative blood loss and a longer operation time than the delayed surgery and upfront surgery groups. There was no significant difference in the number of LN dissections, LN metastasis rate, and postoperative complications among the three groups. Conclusion. Diffuse type of Lauren classification, submucosal invasion, and positive HER-2 are risk factors for residual cancer, while undifferentiated carcinoma, vascular invasion, and positive vertical margin are risk factors for LN metastasis. Delayed additional surgery after ESD (&gt;30 days) has higher intraoperative safety, without affecting the radical resection in early gastric cancer patients.</description><identifier>ISSN: 2291-2789</identifier><identifier>EISSN: 2291-2797</identifier><identifier>DOI: 10.1155/2022/3421078</identifier><identifier>PMID: 35775069</identifier><language>eng</language><publisher>Oakville: Hindawi</publisher><subject>Age ; Body mass index ; Endoscopy ; Gastric cancer ; Gender ; Metastasis ; Pathology ; Regression analysis ; Risk factors ; Surgery ; Ulcers</subject><ispartof>Canadian Journal of Gastroenterology and Hepatology, 2022, Vol.2022, p.1-7</ispartof><rights>Copyright © 2022 Kaipeng Duan et al.</rights><rights>Copyright © 2022 Kaipeng Duan et al. This is an open access article distributed under the Creative Commons Attribution License (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. https://creativecommons.org/licenses/by/4.0</rights><rights>Copyright © 2022 Kaipeng Duan et al. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c491t-1c0b9eb675ee781b9b5c84f8bf2518030a9452a7ae72df43bf76f14d3730dcae3</citedby><cites>FETCH-LOGICAL-c491t-1c0b9eb675ee781b9b5c84f8bf2518030a9452a7ae72df43bf76f14d3730dcae3</cites><orcidid>0000-0001-6535-9426</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239820/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239820/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,877,885,4022,27922,27923,27924,53790,53792</link.rule.ids></links><search><contributor>Zang, Lu</contributor><contributor>Lu Zang</contributor><creatorcontrib>Duan, Kaipeng</creatorcontrib><creatorcontrib>Li, Dongbao</creatorcontrib><creatorcontrib>Shi, Dongtao</creatorcontrib><creatorcontrib>Pei, Jie</creatorcontrib><creatorcontrib>Ren, Jiayu</creatorcontrib><creatorcontrib>Li, Weikang</creatorcontrib><creatorcontrib>Dong, Anqi</creatorcontrib><creatorcontrib>Chen, Tao</creatorcontrib><creatorcontrib>Zhou, Jin</creatorcontrib><title>Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer</title><title>Canadian Journal of Gastroenterology and Hepatology</title><description>Background. Patients with early gastric cancer undergoing noncurative endoscopic submucosal dissection (ESD) have a risk of tumor recurrence and metastasis, and some patients need additional surgery. The purpose of this study was to explore the risk factors of cancer residue and lymph node (LN) metastasis after noncurative ESD for early gastric cancer and to compare the short outcome of early and delayed additional surgery. Methods. The clinicopathological characteristics of 30 early gastric cancer patients who received noncurative ESD and additional surgery were studied retrospectively. Multivariable regression was utilized to examine the independent risk factors for residual cancer and LN metastasis. Receiver operating characteristic curve was used to analyze the multivariable model’s predictive performance. Furthermore, the perioperative safety and radical tumor performance of early surgery (≤30 days, n = 11), delayed surgery (&gt;30 days, n = 11) after ESD, and upfront surgery (n = 59) were compared. Results. Multivariable regression showed that diffuse type of Lauren classification, submucosal invasion, and positive human epidermal growth factor receptor-2 (HER-2) were risk factors for residual cancer. Undifferentiated carcinoma, vascular invasion, and positive vertical margin were risk factors for LN metastasis. The area under the curve (AUC) of the multifactor model predicting cancer residue and LN metastasis was 0.761 and 0.792, respectively. The early surgery group experienced higher intraoperative blood loss and a longer operation time than the delayed surgery and upfront surgery groups. There was no significant difference in the number of LN dissections, LN metastasis rate, and postoperative complications among the three groups. Conclusion. Diffuse type of Lauren classification, submucosal invasion, and positive HER-2 are risk factors for residual cancer, while undifferentiated carcinoma, vascular invasion, and positive vertical margin are risk factors for LN metastasis. 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Patients with early gastric cancer undergoing noncurative endoscopic submucosal dissection (ESD) have a risk of tumor recurrence and metastasis, and some patients need additional surgery. The purpose of this study was to explore the risk factors of cancer residue and lymph node (LN) metastasis after noncurative ESD for early gastric cancer and to compare the short outcome of early and delayed additional surgery. Methods. The clinicopathological characteristics of 30 early gastric cancer patients who received noncurative ESD and additional surgery were studied retrospectively. Multivariable regression was utilized to examine the independent risk factors for residual cancer and LN metastasis. Receiver operating characteristic curve was used to analyze the multivariable model’s predictive performance. Furthermore, the perioperative safety and radical tumor performance of early surgery (≤30 days, n = 11), delayed surgery (&gt;30 days, n = 11) after ESD, and upfront surgery (n = 59) were compared. Results. Multivariable regression showed that diffuse type of Lauren classification, submucosal invasion, and positive human epidermal growth factor receptor-2 (HER-2) were risk factors for residual cancer. Undifferentiated carcinoma, vascular invasion, and positive vertical margin were risk factors for LN metastasis. The area under the curve (AUC) of the multifactor model predicting cancer residue and LN metastasis was 0.761 and 0.792, respectively. The early surgery group experienced higher intraoperative blood loss and a longer operation time than the delayed surgery and upfront surgery groups. There was no significant difference in the number of LN dissections, LN metastasis rate, and postoperative complications among the three groups. Conclusion. Diffuse type of Lauren classification, submucosal invasion, and positive HER-2 are risk factors for residual cancer, while undifferentiated carcinoma, vascular invasion, and positive vertical margin are risk factors for LN metastasis. Delayed additional surgery after ESD (&gt;30 days) has higher intraoperative safety, without affecting the radical resection in early gastric cancer patients.</abstract><cop>Oakville</cop><pub>Hindawi</pub><pmid>35775069</pmid><doi>10.1155/2022/3421078</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-6535-9426</orcidid><oa>free_for_read</oa></addata></record>
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subjects Age
Body mass index
Endoscopy
Gastric cancer
Gender
Metastasis
Pathology
Regression analysis
Risk factors
Surgery
Ulcers
title Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer
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