Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions

Toyokawa,Tatsuya; Inaba,Tomoki; Omote,Shizuma; Okamoto,Akiko; Miyasaka,Rika; Watanabe,Kazuo; Izumikawa,Koichi; Fujita,Isao; Horii,Joichiro; Ishikawa,Shigenao; Morikawa,Tamiya; Murakami,Takako; Tomoda,Jun

doi:10.3892/etm.2015.2265

April-2015 Volume 9 Issue 4

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April-2015 Volume 9 Issue 4

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Article

Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions

Authors:
- Tatsuya Toyokawa
- Tomoki Inaba
- Shizuma Omote
- Akiko Okamoto
- Rika Miyasaka
- Kazuo Watanabe
- Koichi Izumikawa
- Isao Fujita
- Joichiro Horii
- Shigenao Ishikawa
- Tamiya Morikawa
- Takako Murakami
- Jun Tomoda
View Affiliations / Copyright

Affiliations: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Hiroshima, Japan, Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
Pages: 1209-1214
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Published online on: February 5, 2015

https://doi.org/10.3892/etm.2015.2265
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Abstract

Although the frequency of residual disease and recurrence following endoscopic submucosal dissection (ESD) has markedly decreased, a few cases of residual disease and recurrence following ESD are still observed. The aims of the present study were to clarify the causes of non‑curative resection and to investigate the risk factors. A total of 1,123 early gastric neoplasm lesions treated by ESD were investigated. Non‑curative resection was defined as histological positivity of the resected margins, vascular invasion or failure of en bloc resection. Cases of non‑curative resection were classified as being caused by one of three reasons: Inadequate technique, pre‑procedural misdiagnosis or problems in the histological diagnosis. Following classification, the cases of non‑curative and curative resection were compared based on a range of patient characteristics: Procedure time, and size, type and location of the lesions. The frequency of non‑curative resection was 16% (182 lesions). Non‑curative resection occurred due to inadequate technique in 59 cases, pre‑procedural misdiagnosis in 88 cases and problems in the histological diagnosis in 35 cases. Multivariate analysis revealed that a large lesion size, long procedure time and inexperienced endoscopist were associated with a significantly higher risk of non‑curative resection due to an inadequate technique. Furthermore, it was found that lesions located in the upper area of the stomach and cancer with submucosal invasion were associated with a significantly higher risk of non‑curative resection due to pre‑procedural misdiagnosis. In conclusion, the present study has shown that the major reasons for non‑curative resection are an inadequate technique and pre‑procedural misdiagnosis. The risk factors for these problems have been clarified.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions

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