Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey

Background and study aims Positive horizontal margins in resected specimens are sometimes encountered after endoscopic submucosal dissection (ESD) for early gastric cancers, and appropriate treatment strategies for these cases are not established. The aim of this study was to evaluate current empiri...

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Main Authors: Naoki Ishii, Fumio Omata, Junko Fujisaki, Toshiaki Hirasawa, Mitsuru Kaise, Shu Hoteya, Satoshi Tanabe, Kenji Ishido, Ken Ohata, Maiko Takita, Tetsuya Mine, Muneki Igarashi, Tatsuya Yoshida, Yuichi Takeda, Yohei Furumoto, Kenshi Matsumoto, Naohisa Yahagi, Hirotaka Nakashima, Tomonori Wada, Tomoko Tagata, Atsushi Mitsunaga
Format: Article
Language:English
Published: Georg Thieme Verlag KG 2017-05-01
Series:Endoscopy International Open
Online Access:http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-104859
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author Naoki Ishii
Fumio Omata
Junko Fujisaki
Toshiaki Hirasawa
Mitsuru Kaise
Shu Hoteya
Satoshi Tanabe
Kenji Ishido
Ken Ohata
Maiko Takita
Tetsuya Mine
Muneki Igarashi
Tatsuya Yoshida
Yuichi Takeda
Yohei Furumoto
Kenshi Matsumoto
Naohisa Yahagi
Hirotaka Nakashima
Tomonori Wada
Tomoko Tagata
Atsushi Mitsunaga
spellingShingle Naoki Ishii
Fumio Omata
Junko Fujisaki
Toshiaki Hirasawa
Mitsuru Kaise
Shu Hoteya
Satoshi Tanabe
Kenji Ishido
Ken Ohata
Maiko Takita
Tetsuya Mine
Muneki Igarashi
Tatsuya Yoshida
Yuichi Takeda
Yohei Furumoto
Kenshi Matsumoto
Naohisa Yahagi
Hirotaka Nakashima
Tomonori Wada
Tomoko Tagata
Atsushi Mitsunaga
Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey
Endoscopy International Open
author_facet Naoki Ishii
Fumio Omata
Junko Fujisaki
Toshiaki Hirasawa
Mitsuru Kaise
Shu Hoteya
Satoshi Tanabe
Kenji Ishido
Ken Ohata
Maiko Takita
Tetsuya Mine
Muneki Igarashi
Tatsuya Yoshida
Yuichi Takeda
Yohei Furumoto
Kenshi Matsumoto
Naohisa Yahagi
Hirotaka Nakashima
Tomonori Wada
Tomoko Tagata
Atsushi Mitsunaga
author_sort Naoki Ishii
title Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey
title_short Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey
title_full Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey
title_fullStr Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey
title_full_unstemmed Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey
title_sort management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey
publisher Georg Thieme Verlag KG
series Endoscopy International Open
issn 2364-3722
2196-9736
publishDate 2017-05-01
description Background and study aims Positive horizontal margins in resected specimens are sometimes encountered after endoscopic submucosal dissection (ESD) for early gastric cancers, and appropriate treatment strategies for these cases are not established. The aim of this study was to evaluate current empirical treatments for patients with positive horizontal or indeterminable margins after ESD. Patients and methods We performed a multicenter survey and data from 14 hospitals were collected. The pooled proportions of positive horizontal or indeterminable margins and those of patients followed up without early intervention were calculated using a logistic-normal random-effects model. For calculating pooled estimates, subgroup analyses of high- and non-high-volume centers were conducted. Results A total of 11,796 ESD cases were enrolled and 229 patients (2 %) had positive horizontal or indeterminable margins. Ninety-eight cases were treated within 30 days of ESD and 131 cases were followed up without early treatments. Pooled estimates of positive margins in high- and non-high-volume centers were 1 % (95 % CI: 1 % – 2 %) and 2 % (95 % CI: 1 % – 4 %), respectively, and were not heterogeneous (P = 0.191). The proportion of patients followed up without early intervention ranged from 30 % to 100 %. The pooled estimate was 68 % (95 % CI: 50 % – 83 %). The pooled estimates of high- and non-high-volume centers were 65 % (95 % CI: 38 % – 85 %) and 72 % (95 % CI: 44 % – 89 %), respectively, and were not heterogeneous (P = 0.692). Conclusion There was insufficient consensus regarding treatment strategies used for early gastric cancer with positive horizontal or indeterminable margins after ESD. Further studies are required to establish a consensus.
url http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-104859
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spelling doaj-d1e174cc007842459d2c6fa257eb77a02020-11-25T03:17:42ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362017-05-010505E354E36210.1055/s-0043-104859Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter surveyNaoki Ishii0Fumio Omata1Junko Fujisaki2Toshiaki Hirasawa3Mitsuru Kaise4Shu Hoteya5Satoshi Tanabe6Kenji Ishido7Ken Ohata8Maiko Takita9Tetsuya Mine10Muneki Igarashi11Tatsuya Yoshida12Yuichi Takeda13Yohei Furumoto14Kenshi Matsumoto15Naohisa Yahagi16Hirotaka Nakashima17Tomonori Wada18Tomoko Tagata19Atsushi Mitsunaga20Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, JapanDepartment of Gastroenterology, St. Luke’s International Hospital, Tokyo, JapanDepartment of Gastroenterology, Cancer Institute Hospital, Tokyo, JapanDepartment of Gastroenterology, Cancer Institute Hospital, Tokyo, JapanDepartment of Gastroenterology, Toranomon Hospital, Tokyo, JapanDepartment of Gastroenterology, Toranomon Hospital, Tokyo, JapanDepartment of Gastroenterology, Kitasato University East Hospital, Kanagawa, JapanDepartment of Gastroenterology, Kitasato University East Hospital, Kanagawa, JapanDepartment of Gastroenterology, NTT Medical Center Tokyo, Tokyo, JapanDepartment of Gastroenterology, NTT Medical Center Tokyo, Tokyo, JapanDepartment of Gastroenterology, Tokai University School of Medicine, Kanagawa, JapanDepartment of Gastroenterology, Tokai University School of Medicine, Kanagawa, JapanDepartment of Surgery, Kudanzaka Hospital, Tokyo, JapanDepartment of Gastroenterology, Koritsu Showa Hospital, Tokyo, JapanDepartment of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JapanDepartment of Gastroenterology, Juntendo University School of Medicine, Tokyo, JapanDivision of Research and Development for Minimally Invasive Treatment, Cancer center, Keio University School of Medicine, Tokyo, JapanDepartment of Gastroenterology, Foundation of detection of early gastric carcinoma, Tokyo, JapanDepartment of Gastroenterology, Sanraku Hospital, Tokyo, JapanDepartment of Endoscopy, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, JapanDepartment of Endoscopy, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, JapanBackground and study aims Positive horizontal margins in resected specimens are sometimes encountered after endoscopic submucosal dissection (ESD) for early gastric cancers, and appropriate treatment strategies for these cases are not established. The aim of this study was to evaluate current empirical treatments for patients with positive horizontal or indeterminable margins after ESD. Patients and methods We performed a multicenter survey and data from 14 hospitals were collected. The pooled proportions of positive horizontal or indeterminable margins and those of patients followed up without early intervention were calculated using a logistic-normal random-effects model. For calculating pooled estimates, subgroup analyses of high- and non-high-volume centers were conducted. Results A total of 11,796 ESD cases were enrolled and 229 patients (2 %) had positive horizontal or indeterminable margins. Ninety-eight cases were treated within 30 days of ESD and 131 cases were followed up without early treatments. Pooled estimates of positive margins in high- and non-high-volume centers were 1 % (95 % CI: 1 % – 2 %) and 2 % (95 % CI: 1 % – 4 %), respectively, and were not heterogeneous (P = 0.191). The proportion of patients followed up without early intervention ranged from 30 % to 100 %. The pooled estimate was 68 % (95 % CI: 50 % – 83 %). The pooled estimates of high- and non-high-volume centers were 65 % (95 % CI: 38 % – 85 %) and 72 % (95 % CI: 44 % – 89 %), respectively, and were not heterogeneous (P = 0.692). Conclusion There was insufficient consensus regarding treatment strategies used for early gastric cancer with positive horizontal or indeterminable margins after ESD. Further studies are required to establish a consensus.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-104859