Recurrence patterns and outcomes of salvage surgery in cases of non-curative endoscopic submucosal dissection without additional radical surgery for early gastric cancer

Kohei Takizawa, Waku Hatta, Takuji Gotoda, Noboru Kawata, Masahiro Nakagawa, Akiko Takahashi, Mitsuru Esaki, Akira Mitoro, Shinya Yamada, Keiko Tanaka, Mitsuru Matsuda, Jun Takada, Shiro Oka, Hirotaka Ito, Ken Ohnita, Ryo Shimoda, Shu Hoteya, Tsuneo Oyama, Tooru Shimosegawa

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background/Aims: The outcomes of salvage surgery for recurrence after non-curative endoscopic submucosal dissection (ESD) without additional radical surgery for early gastric cancer (EGC) remain unclear. We determined the recurrence patterns and outcomes of salvage surgery in such cases using data from a multicenter, retrospective study. Methods: Of 15,785 patients who underwent ESD for EGC at 19 participating institutions between January 2000 and August 2011, 1,969 failed to meet the current curative criteria after ESD. Of these, 905 patients received no additional treatment. We evaluated the pattern of recurrence, clinical course after salvage surgery, and long-term survival rate for these patients. Results: Over a median 64-month follow-up period, recurrence was detected in 27 patients. Two patients with missing data were excluded. Three, seven, and 15 (60%) patients showed intragastric relapse, regional lymph node metastasis, and distant metastasis, respectively. The first line of treatment for recurrence in 1, 7, 6, and 11 patients was endoscopic treatment, salvage surgery, chemotherapy, and best supportive care, respectively. One patient survived without recurrence for 31 months after salvage surgery, one died of acute myocardial infarction 1 month after salvage surgery, and 5 showed recurrence at 0, 2, 3, 5, and 30 months after salvage surgery and eventually succumbed to the disease. The median survival times for all patients with recurrence and the 7 patients who underwent salvage surgery were 5 months after recurrence and 7 months after salvage surgery, respectively. Conclusion: The survival rate after salvage surgery for recurrence after non-curative ESD without additional radical surgery for EGC is quite low, with distant metastasis being the most common recurrence pattern in these cases.

Original languageEnglish
Pages (from-to)52-58
Number of pages7
JournalDigestion
Volume99
Issue number1
DOIs
Publication statusPublished - 2018 Dec 1

Keywords

  • Early gastric cancer
  • Endoscopic submucosal dissection
  • Lymph node
  • Metastasis
  • Recurrence
  • Salvage surgery

ASJC Scopus subject areas

  • Gastroenterology

Fingerprint Dive into the research topics of 'Recurrence patterns and outcomes of salvage surgery in cases of non-curative endoscopic submucosal dissection without additional radical surgery for early gastric cancer'. Together they form a unique fingerprint.

  • Cite this

    Takizawa, K., Hatta, W., Gotoda, T., Kawata, N., Nakagawa, M., Takahashi, A., Esaki, M., Mitoro, A., Yamada, S., Tanaka, K., Matsuda, M., Takada, J., Oka, S., Ito, H., Ohnita, K., Shimoda, R., Hoteya, S., Oyama, T., & Shimosegawa, T. (2018). Recurrence patterns and outcomes of salvage surgery in cases of non-curative endoscopic submucosal dissection without additional radical surgery for early gastric cancer. Digestion, 99(1), 52-58. https://doi.org/10.1159/000494413