4.6 Article

Metachronous gastric neoplasm beyond 5 years after endoscopic resection for early gastric cancer

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SPRINGER
DOI: 10.1007/s00464-023-09889-9

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Early gastric cancer; Endoscopic submucosal dissection; Endoscopic resection; Metachronous gastric neoplasm; Metachronous gastric cancer

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This study aimed to clarify the long-term clinical outcomes and risk factors of metachronous gastric neoplasm (MGN) 5 years after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). The study found that male sex, severe intestinal metaplasia, tumor-positive lateral margin, <5 mm lateral safety margin, and synchronous adenoma were positive predictive factors for MGN after 5 years post-ESD. In addition, successful eradication of Helicobacter pylori was a negative predictive factor for MGN.
Background and AimsThe natural course of early gastric cancer (EGC) following endoscopic submucosal dissection (ESD) remains unclear. This study aimed to clarify the long-term clinical outcomes and risk factors of metachronous gastric neoplasm (MGN) 5 years after ESD for EGC.MethodsWe performed a retrospective analysis of patients who underwent ESD for EGC from July 2005 to October 2015 in Seoul National University Hospital. Long-term clinical outcomes and risk factors of MGN after 5 years post-ESD were evaluated.ResultsAmong the 2059 patients who underwent ESD for EGC, 1102 were followed up for > 5 years. MGN developed in 132 patients 5 years after ESD. During the median follow-up period of 85 months, the cumulative incidences of MGN and metachronous gastric cancer were 11.7, 16.9, and 27.0 and 7.6, 10.8, and 18.7% after 5, 7, and 10 years, respectively. In multivariable analysis, male sex (odds ratio 1.770; P = 0.042), severe intestinal metaplasia (odds ratio 1.255; P = 0.000), tumor-positive lateral margin (odds ratio 2.711; P = 0.008), < 5 mm lateral safety margin (odds ratio 1.568; P = 0.050), and synchronous adenoma (odds ratio 2.612; P = 0.001) were positive predictive factors, and successful eradication of Helicobacter pylori (odds ratio 0.514; P = 0.024) was a negative predictive factor for MGN after 5 years post-ESD.ConclusionThe cumulative MGN incidence was high even 5 years post-ESD for EGC. Meticulous long-term endoscopic follow-up is mandatory, especially in male patients with underlying intestinal metaplasia, tumor-positive lateral margins, lateral safety margins of < 5 mm, and synchronous adenomas.

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