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KMID : 1188320210150050723
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Gut and Liver
2021 Volume.15 No. 5 p.723 ~ p.731
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Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection
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Yang Hyo-Joon
Lee Wan-Sik
Lee Bong-Eun
Ahn Ji-Yong
Jang Jae-Young
Lim Joo-Hyun
Nam Su-Youn
Kim Jie-Hyun
Min Byung-Hoon
Joo Moon-Kyung
Park Jae-Myung
Shin Woon-Geon
Lee Hang-Lak
Gweon Tae-Geun
Park Moo-In
Choi Jeong-Min
Tae Chung-Hyun
Kim Young-Il
Choi Il-Ju
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Abstract
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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.
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KEYWORD
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Stomach neoplasms, Undifferentiated-type histology, Endoscopic mucosal resection, Margins of excision, Lymphatic metastasis
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