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Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection
- Title
- Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection
- Authors
- Yang, Hyo-Joon; Lee, Wan-Sik; Lee, Bong Eun; Ahn, Ji Yong; Jang, Jae-Young; Lim, Joo Hyun; Nam, Su Youn; Kim, Jie-Hyun; Min, Byung-Hoon; Joo, Moon Kyung; Park, Jae Myung; Shin, Woon Geon; Lee, Hang Lak; Gweon, Tae-Geun; Park, Moo In; Choi, Jeongmin; Tae, Chung Hyun; Kim, Young-Il; Choi, Il Ju
- Ewha Authors
- 태정현
- SCOPUS Author ID
- 태정현
- Issue Date
- 2021
- Journal Title
- GUT AND LIVER
- ISSN
- 1976-2283
2005-1212
- Citation
- GUT AND LIVER vol. 15, no. 5, pp. 723 - 731
- Keywords
- Stomach neoplasms; Undifferentiated-type histology; Endoscopic mucosal resec-tion; Margins of excision; Lymphatic metastasis
- Publisher
- EDITORIAL OFFICE GUT &
LIVER
- Indexed
- SCIE; SCOPUS; KCI
- Document Type
- Article
- 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. (Gut Liver 2021;15:723-731)
- DOI
- 10.5009/gnl20291
- Appears in Collections:
- 의과대학 > 의학과 > Journal papers
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