Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection
- Author:
Hyo-Joon YANG
1
;
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
Author Information
- Publication Type:Original Article
- From:Gut and Liver 2021;15(5):723-731
- CountryRepublic of Korea
- Language:English
-
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.
