Rescue surgery may fix gastric cancer endoscopic resection

Last Updated: 2016-08-12

By Reuters Staff

NEW YORK (Reuters Health) - Additional surgery following non-curative endoscopic submucosal dissection (ESD) in gastric cancer yields a significant improvement in outcome, according to Korean researchers.

Although ESD has shown considerable success, it's not entirely clear whether subsequent surgery for tumors that are out-of-indication for ESD improves overall and disease-free survival in the long term, Dr. Il Ju Choi of the National Cancer Center in Goyang-si and colleagues note in Gastrointestinal Endoscopy, online July 23.

To investigate, the team retrospectively analyzed data on 219 patients whose initial treatment was ESD and a further 1,799 who were treated with surgery. The team then examined outcome in 127 patients who had additional surgery following ESD and 67 such patients who did not have subsequent surgery. Median follow-up lasted about four years.

Mortality and gastric cancer recurrence rates were not significantly different between the immediate-surgery group and the additional-surgery patients.

However, in the 67 patients who did not undergo such surgery, five-year mortality was significantly higher than that in matched initial standard surgery patients (26.0% vs. 14.5%, p=0.04). Moreover, no patients from the matched initial-surgery group showed gastric cancer recurrence over five years compared to 17.0% of the ESD alone group (p=0.002).

In multivariate analyses, "ESD without additional surgery was a significant risk factor for overall mortality and gastric cancer recurrence," the researchers note.

They caution that "the data came from a single high-volume center, and clinical outcomes could be good because of the level of experience of clinicians with ESD or surgery. Thus, it might be difficult to generalize these results to other institutions."

Nevertheless, "additional surgery should be encouraged after non-curative resection to obtain better long-term outcomes," they advise.

Dr. Choi did not respond to requests for comments.

SOURCE: http://bit.ly/2bmTkvd

Gastrointest Endosc 2016.