Copyright
©The Author(s) 2018.
World J Gastroenterol. Sep 7, 2018; 24(33): 3776-3785
Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3776
Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3776
Table 1 Baseline characteristics
Characteristics | ESD | Secondary ESD | P value |
(n = 1595, %) | (n = 28, %) | ||
Gender | 0. 836 | ||
Male | 1117 (70.0) | 19 (67.9) | |
Female | 478 (30.0) | 9 (32.1) | |
Age [yr, mean (SD)] | 64.8 (10.4) | 63.5 (9.2) | 0.528 |
Lesion location | 0.217 | ||
Upper | 127 (8.0) | 3 (11.1) | |
Middle | 633 (39.7) | 15 (53.6) | |
Lower | 835 (52.4) | 10 (35.7) | |
Multiplicity | 250 (15.7) | 2 (7.1) | 0.296 |
Lesion size [mm, mean (SD)] | 17.4 (12.8) | 16.4 (13.2) | 0.664 |
Macroscopic type | < 0.001 | ||
Elevated | 674 (42.3) | 7 (25.0) | |
Flat | 685 (42.9) | 9 (32.1) | |
Depressed | 236 (14.8) | 12 (42.9) | |
WHO classification | < 0.001 | ||
Low grade dysplasia | 610 (38.2) | 8 (28.6) | |
High grade dysplasia | 221 (13.9) | 4 (14.3) | |
Well differentiated | 356 (22.3) | 4 (14.3) | |
Moderately differentiated | 268 (16.8) | 7 (25.0) | |
Poorly differentiated | 76 (4.8) | 3 (10.7) | |
Signet ring cell carcinoma | 64 (4.0) | 0 (0.0) | |
No residual lesion | 0 (0.0) | 2 (7.1) | |
Depth of invasion | < 0.001 | ||
Dysplasia | 831 (52.1) | 12 (42.9) | |
Mucosal cancer | 609 (38.2) | 14 (50.0) | |
Submucosal cancer | 155 (9.7) | 0 (0.0) | |
No residual lesion | 0 (0.0) | 2 (7.1) | |
LVI | 1.000 | ||
No | 1546 (96.9) | 28 (100.0) | |
Yes | 49 (3.1) | 0 (0.0) | |
Lateral margin | 0.381 | ||
Negative | 1521 (95.4) | 26 (92.9) | |
Positive | 74 (4.6) | 2 (7.1) | |
Vertical margin | 0.615 | ||
Negative | 1542 (96.7) | 27 (96.4) | |
Positive | 53 (3.3) | 1 (3.6) |
Table 2 Comparison of procedural outcomes and oncologic outcomes between the primary endoscopic submucosal dissection group and secondary endoscopic submucosal dissection group
ESD | Secondary ESD | P value | |
(n = 1595, %) | (n = 28, %) | ||
Lesion size [mm, mean (SD)] | 17.4 (12.8) | 16.4 (13.2) | 0.664 |
Specimen size [mm, mean (SD)] | 38.1 (14.6) | 47.8 (19.6) | 0.001 |
Whole procedure time [min, mean (SD)] | 55.1 (41.5) | 78.2 (38.0) | 0.004 |
Dissection time [min, mean (SD)] | 36.7 (34.7) | 63.4 (38.0) | < 0.001 |
Dissection speed [mm2/min, mean (SD)] | 38.7 (32.8) | 22.1 (12.7) | < 0.001 |
Complication | 61 (3.8) | 3 (10.7) | 0.095 |
Perforation | 37 (2.3) | 0 (0.0) | |
Bleeding | 15 (0.9) | 1 (3.6) | |
Aspiration pneumonia | 13 (0.8) | 2 (7.1) | |
Hospital stay [d, mean (SD)] | 3.6 (3.2) | 3.9 (2.5) | 0.639 |
En bloc resection | 1574 (98.7) | 26 (92.9) | 0.058 |
Curative resection | 1383 (86.7) | 25 (89.3) | 1.000 |
Additive salvage treatment | 104 (6.5) | 3 (10.7) | 0.425 |
Additive surgery | 85 (5.3) | 2 (7.1) | |
Redo ESD | 16 (1.0) | 1 (3.6) | |
Argon plasma coagulation | 3 (0.2) | 0 (0.0) |
Table 3 Clinicopathologic characteristics according to surgical strategy
Characteristics | Early salvage ESD (n = 6, %) | Late salvage ESD (n = 8, %) | Late secondary ESD (n = 14, %) | P value |
Gender | 0. 909 | |||
Male | 4 (66.7) | 5 (62.5) | 10 (71.4) | |
Female | 2 (33.3) | 3 (37.5) | 4 (28.6) | |
Age [yr, mean (SD)] | 65.4 (10.8) | 61.6 (7.3) | 63.8 (9.9) | 0.749 |
Lesion location | 0.255 | |||
Upper | 2 (33.3) | 0 (0.0) | 1 (7.1) | |
Middle | 2 (33.3) | 4 (50.0) | 9 (64.3) | |
Lower | 2 (33.3) | 4 (50.0) | 4 (28.6) | |
Multiplicity | 0 (0.0) | 1 (12.5) | 1 (7.1) | 0.668 |
Lesion size [mm, mean (SD)] | 19.8 (22.4) | 13.6 (10.9) | 16.4 (9.8) | 0.701 |
Initial method | 0.341 | |||
EMR | 0 (0.0) | 0 (0.0) | 2 (14.3) | |
ESD | 6 (100.0) | 8 (100.0) | 12 (85.7) | |
Macroscopic type | 0.014 | |||
Elevated | 0 (0.0) | 0 (0.0) | 7 (50.0) | |
Flat | 4 (66.7) | 2 (25.0) | 3 (21.4) | |
Depressed | 2 (33.3) | 6 (75.0) | 4 (28.6) | |
WHO classification | 0.081 | |||
Low grade dysplasia | 2 (33.3) | 3 (37.5) | 3 (21.4) | |
High grade dysplasia | 0 (0.0) | 1 (12.5) | 3 (21.4) | |
Well differentiated | 1 (16.7) | 0 (0.0) | 3 (21.4) | |
Moderately differentiated | 1 (16.7) | 4 (50.0) | 2 (14.3) | |
Poorly differentiated | 0 (0.0) | 0 (0.0) | 3 (21.4) | |
Signet ring cell carcinoma | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
No residual lesion | 2 (33.3) | 0 (0.0) | 0 (0.0) | |
Depth of invasion | 0.090 | |||
Dysplasia | 2 (33.3) | 4 (50.0) | 6 (42.9) | |
Mucosal cancer | 2 (33.3) | 4 (50.0) | 8 (57.1) | |
Submucosal cancer | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
No residual lesion | 2 (33.3) | 0 (0.0) | 0 (0.0) | |
LVI | 1.000 | |||
No | 6 (100.0) | 8 (100.0) | 14 (100.0) | |
Yes | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
Lateral margin | 0.341 | |||
Negative | 6 (100.0) | 8 (100.0) | 12 (85.7) | |
Positive | 0 (0.0) | 0 (0.0) | 2 (14.3) | |
Vertical margin | 0.617 | |||
Negative | 6 (100.0) | 8 (100.0) | 13 (92.9) | |
Positive | 0 (0.0) | 0 (0.0) | 1 (7.1) |
Table 4 Comparison of procedural outcomes and oncologic outcomes according to surgical strategy
Early salvage ESD (n = 6, %) | Late salvage ESD (n = 8, %) | Late secondary ESD (n = 14, %) | P value | |
Lesion size [mm, mean (SD)] | 19.8 (22.4) | 13.6 (10.9) | 16.4 (9.8) | 0.701 |
Specimen size [mm, mean (SD)] | 63.0 (33.0) | 46.4 (11.6) | 42.1 (12.8) | 0.084 |
Whole procedure time [min, mean (SD)] | 81.7 (48.5) | 85.9 (24.3) | 72.3 (41.1) | 0.714 |
Dissection time [min, mean (SD)] | 73.2 (46.8) | 73.0 (23.4) | 53.8 (40.7) | 0.421 |
Dissection speed [mm2/min, mean (SD)] | 19.4 (6.8) | 19.0 (7.5) | 24.9 (12.7) | 0.512 |
Method | 0.341 | |||
ESD only | 6 (100.0) | 8 (100.0) | 12 (85.7) | |
ESD plus snaring | 0 (0.0) | 0 (0.0) | 2 (14.3) | |
Complication | 0 (0.0) | 1 (12.5) | 2 (14.3) | 0.627 |
Perforation | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
Bleeding | 0 (0.0) | 0 (0.0) | 1 (7.1) | |
Aspiration pneumonia | 0 (0.0) | 1 (12.5) | 1 (7.1) | |
Hospital stay [d, mean (SD)] | 7.2 (2.9) | 3.0 (1.8) | 3.0 (1.2) | < 0.001 |
Median interval [d, mean (SD)] | 6.5 (3.1) | 129.0 (133.6) | 712.8 (546.5) | 0.001 |
En bloc resection | 6 (100.0) | 8 (100.0) | 12 (85.7) | 0.341 |
Curative resection | 6 (100.0) | 8 (100.0) | 11 (78.6) | 0.186 |
Additive treatment | 0 (0.0) | 0 (0.0) | 3 (21.4) | 0.186 |
Additive surgery | 0 (0.0) | 0 (0.0) | 2 (14.3) | |
Redo ESD | 0 (0.0) | 0 (0.0) | 1 (7.1) |
- Citation: Jung DH, Youn YH, Kim JH, Park JJ, Park H. Secondary endoscopic submucosal dissection for locally recurrent or incompletely resected gastric neoplasms. World J Gastroenterol 2018; 24(33): 3776-3785
- URL: https://www.wjgnet.com/1007-9327/full/v24/i33/3776.htm
- DOI: https://dx.doi.org/10.3748/wjg.v24.i33.3776