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

Authors
 Hyo-Joon Yang  ;  Wan-Sik Lee  ;  Bong Eun Lee  ;  Ji Yong Ahn  ;  Jae-Young Jang  ;  Joo Hyun Lim  ;  Su Youn Nam  ;  Jie-Hyun Kim  ;  Byung-Hoon Min  ;  Moon Kyung Joo  ;  Jae Myung Park  ;  Woon Geon Shin  ;  Hang Lak Lee  ;  Tae-Geun Gweon  ;  Moo In Park  ;  Jeongmin Choi  ;  Chung Hyun Tae  ;  Young-Il Kim  ;  Il Ju Choi 
Citation
 GUT AND LIVER, Vol.15(5) : 723-731, 2021-09 
Journal Title
GUT AND LIVER
ISSN
 1976-2283 
Issue Date
2021-09
MeSH
Endoscopic Mucosal Resection* ; Gastrectomy ; Humans ; Margins of Excision ; Neoplasm Recurrence, Local / surgery ; Republic of Korea ; Retrospective Studies ; Stomach Neoplasms* / surgery ; Treatment Outcome
Keywords
Endoscopic mucosal resection ; Lymphatic metastasis ; Margins of excision ; Stomach neoplasms ; Undifferentiated-type histology
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.
Files in This Item:
T202125631.pdf Download
DOI
10.5009/gnl20291
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188151
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