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Clinicopathological Features of Advanced Gastric Cancers which Were Misjudged and Subjected to Endoscopic Submucosal Dissection.

ABSTRACT: Background and Aims:Endoscopic submucosal dissection (ESD) is widely performed for early gastric cancer (EGC). We have sometimes encountered gastric cancer lesions for which ESD was performed and at which pathologically advanced cancer was found. In this study, we performed clinicopathological examination of lesions whose endoscopic diagnosis and pathology differed substantially. Methods:ESD was performed for 2,194 gastric cancer lesions (1,753 cases) in our institute from April 2005 through March 2015. The vertical margin was positive or status unknown in 51 lesions (2.3%); among these, muscularis propria (MP) or deeper infiltration was identified in 6 lesions from specimens obtained during subsequent surgery. In 1 lesion with MP invasion, the vertical margin was negative. We evaluated the clinicopathological features of these 7 lesions and retrospectively reviewed endoscopic indicators of submucosal invasion for EGC on white light imaging (WLI), narrow-band imaging magnifying endoscopy (NBI-ME), and endoscopic ultrasonography (EUS) performed previously. Results:Average age was 73.2 ± 7.2 years, and all cases were men. The 7 lesions diagnosed as advanced cancer were 0.32% of 2,194 lesions and were all located in the U region (fundus). On retrospective review of endoscopic findings, 2 of 7 lesions on WBI, 3 of 6 lesions on NBI-ME, and 2 of 5 lesions on EUS met the criteria for indicating submucosal invasion of EGC. No lesions had findings on all 3 modalities. Conclusion:In rare cases, advanced gastric cancer could not be accurately diagnosed by endoscopy using various modalities. Each case had special characteristics making identification of deep infiltration difficult.

SUBMITTER: Ochiai Y

PROVIDER: S-EPMC7071798 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Clinicopathological Features of Advanced Gastric Cancers which Were Misjudged and Subjected to Endoscopic Submucosal Dissection.

Ochiai Yorinari Y Kikuchi Daisuke D Inoshita Naoko N Hayasaka Junnosuke J Suzuki Yugo Y Tanaka Masami M Nomura Kosuke K Odagiri Hiroyuki H Yamashita Satoshi S Matsui Akira A Iizuka Toshiro T Kitagawa Masanobu M Hoteya Shu S

Gastroenterology research and practice 20200302

<h4>Background and aims</h4>Endoscopic submucosal dissection (ESD) is widely performed for early gastric cancer (EGC). We have sometimes encountered gastric cancer lesions for which ESD was performed and at which pathologically advanced cancer was found. In this study, we performed clinicopathological examination of lesions whose endoscopic diagnosis and pathology differed substantially.<h4>Methods</h4>ESD was performed for 2,194 gastric cancer lesions (1,753 cases) in our institute from April 2 ...[more]

PMID: 32190041

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Project description:ObjectivesTo investigate the treatment effects of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC).DesignMeta-analysis.MethodsWe systematically searched three electronic databases, including PubMed, EmBase and the Cochrane library for studies published with inception to January 2018. The eligible studies should be evaluated for the efficacy and safety of ESD versus EMR for patients with EGC. The summary ORs and standard mean differences (SMDs) with 95% CIs were employed as effect estimates. Sensitivity analyses were conducted to evaluate the impact of single study on overall analysis. Subgroup analyses were performed for investigated outcomes to evaluate the treatment effects of ESD versus EMR for patients with EGC with specific subsets.ResultsEighteen studies, with a total of 6723 patients with EGC, were included in final analysis. The summary ORs indicated that patients with EGC who received ESD were associated with an increased incidence of en bloc resection (OR: 9.00; 95% CI: 6.66 to 12.17; p<0.001), complete resection (OR: 8.43; 95% CI: 5.04 to 14.09; p<0.001) and curative resection (OR: 2.92; 95% CI: 1.85 to 4.61; p<0.001) when compared with EMR. Furthermore, ESD was associated with lower risk of local recurrence (OR: 0.18; 95% CI: 0.09 to 0.34; p<0.001). In addition, there was no significant difference between ESD and EMR for the risk of bleeding (OR: 1.26; 95% CI: 0.88 to 1.80; p=0.203). Though, ESD was correlated with greater risk of perforation (OR: 2.55; 95% CI: 1.48 to 4.39; p=0.001), and longer operation time (SMD: 1.12; 95% CI: 0.13 to 2.10; p=0.026) as compared with EMR. Additionally, several different features observed in included studies and patients could bias the effectiveness of ESD versus EMR in patients with EGC.ConclusionsESD is superior than EMR for en bloc resection, complete resection, curative resection and local recurrence, while it increased perforation risk and longer operation time.

Dataset Information

Clinicopathological Features of Advanced Gastric Cancers which Were Misjudged and Subjected to Endoscopic Submucosal Dissection.

Publications

Clinicopathological Features of Advanced Gastric Cancers which Were Misjudged and Subjected to Endoscopic Submucosal Dissection.

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