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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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2022/3421078 |
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| author | Kaipeng Duan Dongbao Li Dongtao Shi Jie Pei Jiayu Ren Weikang Li Anqi Dong Tao Chen Jin Zhou |
| author_facet | Kaipeng Duan Dongbao Li Dongtao Shi Jie Pei Jiayu Ren Weikang Li Anqi Dong Tao Chen Jin Zhou |
| author_sort | Kaipeng Duan |
| collection | DOAJ |
| 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. |
| format | Article |
| id | doaj-art-62a8e23e42b94ab68e105ecda50c6de8 |
| institution | Kabale University |
| issn | 2291-2797 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-62a8e23e42b94ab68e105ecda50c6de82025-02-03T06:04:44ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27972022-01-01202210.1155/2022/3421078Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric CancerKaipeng Duan0Dongbao Li1Dongtao Shi2Jie Pei3Jiayu Ren4Weikang Li5Anqi Dong6Tao Chen7Jin Zhou8Department of General SurgeryDepartment of General SurgeryDepartment of GastroenterologyDepartment of General SurgeryDepartment of General SurgeryDepartment of General SurgeryDepartment of General SurgeryDepartment of General SurgeryDepartment of General SurgeryBackground. 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.http://dx.doi.org/10.1155/2022/3421078 |
| spellingShingle | Kaipeng Duan Dongbao Li Dongtao Shi Jie Pei Jiayu Ren Weikang Li Anqi Dong Tao Chen Jin Zhou Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer Canadian Journal of Gastroenterology and Hepatology |
| title | Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer |
| title_full | Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer |
| title_fullStr | Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer |
| title_full_unstemmed | Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer |
| title_short | Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer |
| title_sort | risk factors and timing of additional surgery after noncurative esd for early gastric cancer |
| url | http://dx.doi.org/10.1155/2022/3421078 |
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