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

IF 2.7 4区 医学 Q2 Medicine
Canadian Journal of Gastroenterology and Hepatology Pub Date : 2022-06-21 eCollection Date: 2022-01-01 DOI:10.1155/2022/3421078
Kaipeng Duan, Dongbao Li, Dongtao Shi, Jie Pei, Jiayu Ren, Weikang Li, Anqi Dong, Tao Chen, Jin Zhou
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引用次数: 1

Abstract

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.

Abstract Image

Abstract Image

早期胃癌无治愈性ESD后追加手术的危险因素及时机。
背景:早期胃癌患者行内镜下粘膜下剥离术(ESD)有肿瘤复发和转移的风险,部分患者需要额外手术治疗。本研究的目的是探讨早期胃癌非治愈性ESD术后肿瘤残留和淋巴结转移的危险因素,并比较早期和延迟追加手术的短期预后。方法:回顾性分析30例早期胃癌患者的临床病理特点。采用多变量回归分析残余癌和淋巴结转移的独立危险因素。采用受试者工作特征曲线分析多变量模型的预测性能。比较ESD术后早期手术(≤30天,n = 11)、延迟手术(>30天,n = 11)和术前手术(n = 59)的围手术期安全性和肿瘤根治性表现。结果:多变量回归显示弥漫性Lauren分型、粘膜下浸润、人表皮生长因子受体2 (HER-2)阳性是残留癌发生的危险因素。未分化癌、血管浸润和垂直边缘阳性是淋巴结转移的危险因素。预测肿瘤残留和淋巴结转移的多因素模型的曲线下面积(AUC)分别为0.761和0.792。早期手术组术中出血量高于延迟手术组和术前手术组,手术时间较术前手术组长。三组在淋巴结清扫数、淋巴结转移率、术后并发症方面无显著差异。结论:Lauren弥漫性分型、粘膜下浸润、HER-2阳性是淋巴结残留癌的危险因素,未分化癌、血管浸润、垂缘阳性是淋巴结转移的危险因素。ESD后延迟追加手术(>30天)术中安全性更高,不影响早期胃癌患者根治性切除。
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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
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