How to Cite
Abstract
Additional surgical operation with lymph dissection is necessary after early gastric cancer’s (ERG) endoscopic resection (ER) and if tumor’s characteristics exceed certain JGCA [1] extended ER indications. However, during the research of surgical material from patients, who have undergone not radical ER, regional lymphogenic metastatic spreading is detected in small number of cases [2, 3, 4, 5]. Considering the low risk of lymph node metastasis and this patients group’s survivability, the issue of additional surgical operation’s importance is still questionable. In our research, we formed a rule for determining a tactic to treat ERG with expanded indications. The research consisted of two stages. During the first stage, we selected 229 patients with expanded indications from a total group with ERG (404 patients). Considering the low mortality risk from progressing ERG (14,4%, 33/229) during 10 years of observation (observation time median = 132 months), and using multi-dimensional logical analysis, we developed a regression equation to measure the risk of ERG’s lymph node metastasis amongst this category of patients. During the second stage, we divided 229 patients into 2 groups - with low and high risk of ERG’s lymph node metastasis - using the regression equation. The level of metastasis correlates with indications of tumor-specific survivability and survivability without indications of progression. The frequency of correct predictions is 83, %.References
Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2010 (ver. 3) // Gastric Cancer. - 2011. - Vol. 14. - P. 113 - 123.
Ito H., Inoue H., Ikeda H. et al. Surgical outcomes and clinicopathological characteristics of patients who underwent potentially noncurative endoscopic resection for gastric cancer: a report of a single-center experience // Gastroenterol Res Pract. - 2013. - Vol. 2013. - P. 427405.
Hatta W., Gotoda T., Oyama T. et al. Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection of early gastric cancer? A multicenter retrospective study in Japan // J. Gastroenterol. - 2016. - Vol. 52. - P. 175 - 184. - DOI: 10.1007/s00535-016-1210-4
Hatta W., Gotoda T., Oyama T. et al. A Scoring System to Stratify Curability after Endoscopic Submucosal Dissection for Early Gastric Cancer: "eCura system // The American Journal of Gastroenterology. - 2017. - Vol. 112(6). - P. 874-881. -. DOI: 10.1038/ajg.2017.95
Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4) // Gastric Cancer. - 2017. - Vol. 20. - P. 1-19.
Bosman F.T., Carneiro F., Hruban R.H. et al. WHO classification of tumours of the digestive system. - World Health Organization, Lyon: IARC Press, 2010.
Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. an attempt at a histo-clinical classification // Acta Pathol Microbiol Scand. - 1965. - Vol. 64. - P. 31-49.
Bausys R., Bausys A., Maneikis K. et al. Safety of expanded criteria for endoscopic resection of early gastric cancer in a Western cohort // BMC Surgery. - 2018. - Vol. 18(1). - DOI: 10.1186/s12893-018-0414-3
Yang H.J., Kim S.G., Lim J.H. et al. Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer // Surg Endosc. - 2015. - Vol. 29. - P. 1145-1155. - DOI: 10.1007/s00464-014-3780-7
Kwee R.M., Kwee T.C. Predicting lymph node status in early gastric cance // Gastric Cancer. - 2008. - Vol. 11. - P. 134-148.
Sekiguchi M., Oda I., Taniguchi H. at al. Risk stratification and predictive risk-scoring model for lymph node metastasis in early gastric cancer // Journal of Gastroenterology. - 2016. - Vol. 51(10). - P. 961-970. - DOI: 10.1007/s00535-016-1180-6
Suzuki S., Gotoda T., Hatta W. et al. Survival benefit of additional surgery after non-curative endoscopic submucosal dissection for early gastric Cancer: a propensity score matching analysis // Ann Surg Oncol. - 2017. - Vol. 24(11). - P. 3353-3360.
Kim E.R., Lee H., Min B.H. et al. Effect of rescue surgery after noncurative endoscopic resection of early gastric cancer // Br J Surg. - 2015. - Vol. 102. - P. 1394-1401.
Kusano C., Iwasaki M., Kaltenbach T. et al. Should elderly patients undergo additional surgery after non-curative endoscopic resection for early gastric cancer? Long-term comparative outcomes // Am J Gastroenterol. - 2011. - Vol. 106. - P. 1064-1069.
Nie R.C., Yuan S.Q., Li YF. et al. Additional gastrectomy in early-stage gastric cancer after non-curative endoscopic resection: a meta-analysis // Gastroenterology Report. -2019. - Vol. 7(2). - P. 91-97. - DOI: 10.1093/gastro/goz007
Songun I., Putter H., Kranenbarg E.M. et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial // Lancet Oncol. -2010. - Vol. 11. - P. 439-449.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2020