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Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

  • Jang, Mi Young (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Cho, Jin Woong (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Oh, Wang Guk (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Ko, Sung Jun (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Han, Shang Hoon (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Baek, Hoon Ki (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Lee, Young Jae (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Kim, Ji Woong (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Jung, Gum Mo (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Cho, Yong Keun (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center)
  • Received : 2013.01.29
  • Accepted : 2013.06.10
  • Published : 2013.11.01

Abstract

Background/Aims: Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD. Methods: In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study. Results: In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%. Conclusions: We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.

Keywords

References

  1. Lee H, Yun WK, Min BH, et al. A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 2011;25:1985-1993. https://doi.org/10.1007/s00464-010-1499-7
  2. Isomoto H, Shikuwa S, Yamaguchi N, et al. Endoscopic submucosal dissection for early gastric cancer: a largescale feasibility study. Gut 2009;58:331-336. https://doi.org/10.1136/gut.2008.165381
  3. Goto O, Fujishiro M, Kodashima S, Ono S, Omata M. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 2009;41:118-122. https://doi.org/10.1055/s-0028-1119452
  4. Kato M, Nishida T, Tsutsui S, et al. Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group. J Gastroenterol 2011;46:325-331. https://doi.org/10.1007/s00535-010-0350-1
  5. Chung IK, Lee JH, Lee SH, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 2009;69:1228-1235. https://doi.org/10.1016/j.gie.2008.09.027
  6. Arima N, Adachi K, Katsube T, et al. Predictive factors for metachronous recurrence of early gastric cancer after endoscopic treatment. J Clin Gastroenterol 1999;29:44-47. https://doi.org/10.1097/00004836-199907000-00011
  7. Nakajima T, Oda I, Gotoda T, et al. Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance? Gastric Cancer 2006;9:93-98. https://doi.org/10.1007/s10120-006-0372-9
  8. Kato M, Nishida T, Yamamoto K, et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group. Gut 2012 Aug 21 [Epub]. 10.1136/gutjnl-2011-301647.
  9. Takeda J, Toyonaga A, Koufuji K, et al. Early gastric cancer in the remnant stomach. Hepatogastroenterology 1998;45:1907-1911.
  10. Nicholls JC. Stump cancer following gastric surgery. World J Surg 1979;3:731-736. https://doi.org/10.1007/BF01654802
  11. Han JS, Jang JS, Choi SR, et al. A study of metachronous cancer after endoscopic resection of early gastric cancer. Scand J Gastroenterol 2011;46:1099-1104. https://doi.org/10.3109/00365521.2011.591427
  12. Nasu J, Doi T, Endo H, Nishina T, Hirasaki S, Hyodo I. Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection. Endoscopy 2005;37:990-993. https://doi.org/10.1055/s-2005-870198
  13. Seo JH, Park JC, Kim YJ, Shin SK, Lee YC, Lee SK. Undifferentiated histology after endoscopic resection may predict synchronous and metachronous occurrence of early gastric cancer. Digestion 2010;81:35-42. https://doi.org/10.1159/000235921
  14. Yoo JH, Shin SJ, Lee KM, et al. How can we predict the presence of missed synchronous lesions after endoscopic submucosal dissection for early gastric cancers or gastric adenomas? J Clin Gastroenterol 2013;47:e17-e22. https://doi.org/10.1097/MCG.0b013e31825c0b69
  15. Moertel CG, Bargen JA, Soule EH. Multiple gastric cancers: review of the literature and study of 42 cases. Gastroenterology 1957;32:1095-1103.
  16. Fukase K, Kato M, Kikuchi S, et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008;372:392-397. https://doi.org/10.1016/S0140-6736(08)61159-9
  17. Uemura N, Mukai T, Okamoto S, et al. Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol Biomarkers Prev 1997;6:639-642.
  18. Miyoshi E, Haruma K, Hiyama T, et al. Microsatellite instability is a genetic marker for the development of multiple gastric cancers. Int J Cancer 2001;95:350-353. https://doi.org/10.1002/1097-0215(20011120)95:6<350::AID-IJC1061>3.0.CO;2-A
  19. Kawamura A, Adachi K, Ishihara S, et al. Correlation between microsatellite instability and metachronous disease recurrence after endoscopic mucosal resection in patients with early stage gastric carcinoma. Cancer 2001;91:339-345. https://doi.org/10.1002/1097-0142(20010115)91:2<339::AID-CNCR1007>3.0.CO;2-2
  20. Hasuo T, Semba S, Li D, et al. Assessment of microsatellite instability status for the prediction of metachronous recurrence after initial endoscopic submucosal dissection for early gastric cancer. Br J Cancer 2007;96:89-94. https://doi.org/10.1038/sj.bjc.6603532
  21. Semba S, Hasuo T, Satake S, Nakayama F, Yokozaki H. Prognostic significance of intestinal claudins in highrisk synchronous and metachronous multiple gastric epithelial neoplasias after initial endoscopic submucosal dissection. Pathol Int 2008;58:371-377. https://doi.org/10.1111/j.1440-1827.2008.02238.x
  22. Tada M, Higaki S, Matsumoto Y, Ryo S, Karita M. Strip biopsy: its problems and measures implied by a longterm follow-up study (simultaneous and metachronous multiple cancers). Stomach Intest 1993;28:1441-1451.
  23. Kobayashi M, Narisawa R, Sato Y, Takeuchi M, Aoyagi Y. Self-limiting risk of metachronous gastric cancers after endoscopic resection. Dig Endosc 2010;22:169-173. https://doi.org/10.1111/j.1443-1661.2010.00987.x

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