1
|
Song BG, Kim GH, Cho CJ, Kim HR, Min YW, Lee H, Min BH, Song HJ, Kim YH, Lee JH, Jung HY, Zo JI, Shim YM. Close Observation versus Additional Surgery after Noncurative Endoscopic Resection of Esophageal Squamous Cell Carcinoma. Dig Surg 2021; 38:247-254. [PMID: 33910202 DOI: 10.1159/000515717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION After noncurative endoscopic submucosal dissection (ESD) of superficial esophageal squamous cell carcinoma (SESCC), additional esophagectomy is generally recommended. However, considering its high mortality and morbidity, it is uncertain if additional surgery improves the clinical outcomes. This study aimed to compare the clinical outcomes between patients who were observed without additional treatment and those who underwent radical esophagectomy. METHODS A total of 52 patients with SESCC who underwent complete but noncurative ESD from January 2008 to December 2016 at the Samsung Medical Center and Asan Medical Center in Korea were retrospectively analyzed. Clinicopathologic characteristics and oncologic outcomes were compared between the observation group (n = 23) and the additional surgery group (n = 29). RESULTS During a mean follow-up of 34.4 and 41.7 months, respectively, the rates of death (observation vs. surgery, 17.4 vs. 10.3%; p = 0.686), recurrence (observation vs. surgery, 13 vs. 17.2%; p = 1.000), and disease-specific death (observation vs. surgery, 4.3 vs. 6.9%; p = 1.000) did not significantly differ between the 2 groups. The 3-year overall survival was 86.3 and 96.4%, respectively (p = 0.776). The 3-year recurrence-free survival (observation vs. surgery, 85.0 vs. 88.7%; p = 0.960) and disease-specific survival (observation vs. surgery, 95.2 vs. 96.4%; p = 0.564) also did not significantly differ. CONCLUSIONS The clinical outcomes of close observation of noncuratively resected SESCC are comparable to those of additional surgery, at least in the midterm. The wait-and-see strategy could be a feasible management option after noncurative ESD of SESCC in selected patients.
Collapse
Affiliation(s)
- Byeong Geun Song
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ga Hee Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Charles J Cho
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| |
Collapse
|
2
|
Clinical feasibility and oncologic safety of primary endoscopic submucosal dissection for clinical submucosal invasive early gastric cancer. J Cancer Res Clin Oncol 2021; 147:3051-3061. [PMID: 33666751 DOI: 10.1007/s00432-021-03581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to evaluate the clinical feasibility and oncologic safety of primary endoscopic submucosal dissection for cT1bN0M0 gastric cancer by identifying patients who had undergone curative resection after endoscopic submucosal dissection and patients who had undergone primary surgery but could be treated with endoscopic submucosal dissection. METHODS A single-center retrospective cohort study was conducted on patients with cT1bN0M0 gastric cancer (size: ≤ 30 mm) and differentiated histology from January 2007 to May 2017. Submucosal invasion was evaluated using conventional endoscopy and endoscopic ultrasonography. Patients were divided into the primary endoscopic submucosal dissection and primary surgery groups according to initial treatment. RESULTS Curative resection rate was 65.0% (91/140) in the primary endoscopic submucosal dissection group. Of patients in the primary surgery group, 49.1% (82/167) were considered eligible for endoscopic submucosal dissection. No differences in en bloc resection rate were observed between pT1a and pT1b gastric cancers after endoscopic submucosal dissection (97.8 vs. 97.9%). However, the negative horizontal margin rate was higher in pT1a gastric cancer than pT1b gastric cancer (98.9 vs. 91.3%). There was no difference in overall survival among the curative treatment groups (log rank P = 0.310). CONCLUSION In this study, 173 (56.4%) out of 307 patients with cT1bN0M0 gastric cancer could avoid unnecessary surgery if primary endoscopic submucosal dissection was used. Based on these findings, it is necessary to add an appropriate indication for endoscopic submucosal dissection in patients with cT1b gastric cancer. Further management could be determined based on pathologic findings after primary endoscopic submucosal dissection.
Collapse
|