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Recurrence rate of intramucosal gastric cancer with positive vertical margin due to lesion damage during endoscopic submucosal dissection

Journal Volume 84 - 2021
Issue Fasc.2 - Original articles
Author(s) J. Hayasaka 1 2, D. Kikuchi 1, K. Nomura 1, H. Odagiri 1, Y. Ochiai 1, Y. Suzuki 1, Y. Fukuma 1, M. Tanaka 1, S. Yamashita 1, A. Matsui 1, N. Inoshita 1, M. Kitagawa 2, S. Hoteya 1
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PAGES 289-294
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DOI10.51821/84.2.289
Affiliations:
(1) Department of Gastroenterology, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan
(2) Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan

Background and study aim: In principle, additional surgery is performed after endoscopic submucosal dissection for early gastric cancer if the vertical margin is positive, regardless of lesion damage. The recurrence rate of vertical margin-positive lesions due to lesion damage after endoscopic submucosal dissection is unknown, and unnecessary surgeries may be performed. In this study, we investigated whether there was a difference in the recurrence rate between vertical margin-positive lesions due to lesion damage and vertical margin-negative lesions.

Patients and methods: We included 1,294 intramucosal gastric cancer lesions that were resected by endoscopic submucosal dissection between January 2008 and December 2016, without additional surgery. The lesions were divided into the Damage and No damage groups based on vertical margin status. The Damage group had only one non-curative indication: a positive vertical margin due to lesion damage. The No damage group had no noncurative indications. We compared the recurrence rate between the Damage and No damage groups.

Results: The recurrence rates of the Damage and No damage groups were 0% (0/23; 95% confidence interval: 0-14.8%) and 0% (0/1,271; 95% confidence interval: 0-0.003%), respectively, with no statistically significant difference.

Conclusions: In intramucosal gastric cancer, the recurrence rate of vertical margin-positive lesions due to lesion damage was 0%, which did not differ from that of vertical margin-negative lesions with curative resection. Follow-up, instead of additional surgery, may be an option for patients with non-curative resection when the only non-curative indication is a positive vertical margin due to lesion damage.

Keywords: early gastric cancer, endoscopic submucosal dissection, neoplasm, recurrence, vertical margin.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.