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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

  • Published online on: February 5, 2015     https://doi.org/10.3892/etm.2015.2265
  • Pages: 1209-1214
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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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April-2015
Volume 9 Issue 4

Print ISSN: 1792-0981
Online ISSN:1792-1015

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Spandidos Publications style
Toyokawa T, Inaba T, Omote S, Okamoto A, Miyasaka R, Watanabe K, Izumikawa K, Fujita I, Horii J, Ishikawa S, Ishikawa S, et al: Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions. Exp Ther Med 9: 1209-1214, 2015
APA
Toyokawa, T., Inaba, T., Omote, S., Okamoto, A., Miyasaka, R., Watanabe, K. ... Tomoda, J. (2015). Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions. Experimental and Therapeutic Medicine, 9, 1209-1214. https://doi.org/10.3892/etm.2015.2265
MLA
Toyokawa, T., Inaba, T., Omote, S., Okamoto, A., Miyasaka, R., Watanabe, K., Izumikawa, K., Fujita, I., Horii, J., Ishikawa, S., Morikawa, T., Murakami, T., Tomoda, J."Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions". Experimental and Therapeutic Medicine 9.4 (2015): 1209-1214.
Chicago
Toyokawa, T., Inaba, T., Omote, S., Okamoto, A., Miyasaka, R., Watanabe, K., Izumikawa, K., Fujita, I., Horii, J., Ishikawa, S., Morikawa, T., Murakami, T., Tomoda, J."Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions". Experimental and Therapeutic Medicine 9, no. 4 (2015): 1209-1214. https://doi.org/10.3892/etm.2015.2265