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Review
, 7 (2), 91-97

Additional Gastrectomy in Early-Stage Gastric Cancer After Non-Curative Endoscopic Resection: A Meta-Analysis

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Review

Additional Gastrectomy in Early-Stage Gastric Cancer After Non-Curative Endoscopic Resection: A Meta-Analysis

Run-Cong Nie et al. Gastroenterol Rep (Oxf).

Abstract

Background and objective: The role of additional gastrectomy after non-curative endoscopic resection remains uncertain. The present meta-analysis aimed to explore the risk factors for early-stage gastric-cancer patients after non-curative endoscopic resection and evaluate the efficacy of additional gastrectomy.

Methods: Relevant studies that reported additional gastrectomy after non-curative endoscopic resection were comprehensively searched in MedLine, Web of Science and EMBASE. We first investigated the risk factors for residual tumor and lymph-node metastasis after non-curative endoscopic resection and then analysed the survival outcome, including 5-year overall survival (OS) and 5-year disease-free survival, of additional gastrectomy.

Results: Twenty-one studies comprising 4870 cases were included in the present study. We found that residual tumor was associated with larger tumor size (>3 cm) (odds ratio [OR] = 2.81, P < 0.001), undifferentiated tumor type (OR = 1.78, P = 0.011) and positive horizontal margin (OR = 9.78, P < 0.001). Lymph-node metastasis was associated with larger tumor size (>3 cm) (OR = 1.73, P < 0.001), elevated tumor type (OR = 1.60, P = 0.035), deeper tumor invasion (>SM1) (OR = 2.68, P < 0.001), lymphatic invasion (OR = 4.65, P < 0.001) and positive vertical margin (OR = 2.30, P < 0.001). Patients who underwent additional gastrectomy had longer 5-year OS (hazard ratio [HR] = 0.34, P < 0.001), 5-year disease-free survival (HR = 0.52, P = 0.001) and 5-year disease-specific survival (HR = 0.50, P < 0.001) than those who did not. Moreover, elderly patients also benefited from additional gastrectomy regarding 5-year OS (HR = 0.41, P = 0.001).

Conclusions: Additional gastrectomy with lymph-node dissection might improve the survival of early-stage gastric-cancer patients after non-curative endoscopic resection. However, risk stratification should be performed to avoid excessive treatment.

Keywords: Early gastric cancer; endoscopic resection; gastrectomy; non-curative.

Figures

Figure 1.
Figure 1.
Study flow diagram of the included studies. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; ER, endoscopic resection.
Figure 2.
Figure 2.
Forest plot assessing survival outcome comparing gastrectomy groups to non-gastrectomy groups. A, overall survival (HR = 0.34, P < 0.001); B, disease-free survival (HR = 0.52, P = 0.001); C, disease-special survival (HR = 0.50, P = 0.001); D, overall survival in the elderly patient subgroup (HR = 0.41, P = 0.001). HR, hazard ratio; CI, confidence interval.

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References

    1. Torre LA, Bray F, Siegel RL et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87–108. - PubMed
    1. Sano T, Kobori O, Muto T et al. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 1992;79:241–4. - PubMed
    1. Information Committee of Korean Gastric Cancer Association. Korean Gastric Cancer Association Nationwide Survey on Gastric Cancer in 2014. J Gastric Cancer 2016;16:131–40. - PMC - PubMed
    1. The general rules for the gastric cancer study in surgery. Jpn J Surg 1973;3:61–71. - PubMed
    1. Uedo N, Iishi H, Tatsuta M et al. Longterm outcomes after endoscopic mucosal resection for early gastric cancer. Gastric Cancer 2006;9:88–92. - PubMed
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