4 research outputs found
Validation of classic and expanded criteria for endoscopic submucosal dissection of early gastric cancer: 7 years of experience in a Western tertiary cancer center
OBJECTIVE: Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center. METHODS: We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisherâs exact test and chi-square tests, with 95% confidence intervals. RESULTS: In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (±11.7). The average procedure length was 113.9 minutes (±71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with ââonly-by-sizeââ expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; ±14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014). CONCLUSION: These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries
Risk assessment of lymph node metastases in early gastric adenocarcinoma fullfilling expanded endoscopic resection criteria in patients undergoing gastrectomy
INTRODUĂĂO: O adenocarcinoma gĂĄstrico precoce (AGP) atinge atĂ© a camada submucosa em profundidade, independentemente da presença de metĂĄstases linfonodais (MLF). Tumores mucosos, bem diferenciados, menores que 20 mm e sem ulceração sĂŁo candidatos Ă ressecção endoscĂłpica (RE) por mucosectomia com taxas de MLF praticamente nulas. Com o advento da tĂ©cnica de dissecção endoscĂłpica da submucosa (ESD) e apĂłs observar ausĂȘncia de MLF em grande sĂ©rie de pacientes no JapĂŁo, foi sugerido que os critĂ©rios clĂĄssicos pudessem ser expandidos, evitando a gastrectomia em alguns pacientes. Em paĂses ocidentais autores e sociedades tĂȘm visto com restrição a ESD para critĂ©rios expandidos devido Ă observação de MLF em alguns subgrupos. A anĂĄlise crĂtica e validação dos critĂ©rios expandidos de RE para tratamento do AGP em coorte brasileira poderĂĄ indicar os pacientes com menor risco de metĂĄstases linfonodais nesta população, de modo a individualizar o tratamento com excelĂȘncia e qualidade de vida. OBJETIVO: Avaliar a presença MLF em produtos de gastrectomia com linfadenectomia de pacientes elegĂveis Ă ressecção endoscĂłpica seguindo os critĂ©rios clĂĄssicos e expandidos. MĂTODO: InclusĂŁo de pacientes com AGP submetidos a tratamento cirĂșrgico com dissecção linfonodal. Estadiamento linfonodal e avaliação de caracterĂsticas clĂnicas, macroscĂłpicas e histopatolĂłgicas segundo critĂ©rios de RE. RESULTADOS: Foram incluĂdos 389 espĂ©cimens cirĂșrgicos de gastrectomia, dentre os quais 135 cumpriam critĂ©rios para ressecção endoscĂłpica. Nenhum dos 31 pacientes com critĂ©rios clĂĄssicos apresentou MLF (N = 31; 0% IC95% 0 - 13,4%). Dos 104 com critĂ©rios expandidos, 3 apresentaram MLF (N = 104; 2,9% IC95% 0,7 - 8,6%), todos pertencentes ao grupo de tumores indiferenciados sem ulceração e menores que 20 mm. Dos pacientes com indicação de tratamento cirĂșrgico houve 50 MLF positivos (N = 254; 19,7% IC95% 15,3 - 25,1%). CONCLUSĂO: Existe risco mĂnimo de metĂĄstases linfonodais quando adotados os critĂ©rios expandidos de RE. Este risco Ă© praticamente nulo para os critĂ©rios clĂĄssicos e quando se exclui o tumor indiferenciado do critĂ©rio expandidoINTRODUCTION: Early gastric cancer (EGC) is known to present low rate of lymph nodal metastasis (LNM). Gastrectomy with D2 lymphadenectomy is usually curative for EGC. Endoscopic submucosal dissection (ESD) is a well-accepted treatment modality for lesions that meet the classic criteria, a well-differentiated adenocarcinoma measuring less than 20 mm size and without ulceration. Expanded criteria for ESD have been recently proposed, based on null LNM rate from large gastrectomies series coming from Japan. The expanded criteria for ESD are as follows: intramucosal non-ulcerative well-differentiated tumor > 20 mm, intramucosal ulc mo <= 30 mm, intramucosal non-ulcera mo <= 20 mm, or superficially submucosal ( m1) mo <= 30 mm. There is some resistance to adoption of the expanded criteria, since patients with positive LNM have already been reported in western centers. OBJECTIVE: Evaluate LNM staging in patients who met the expanded endoscopic treatment criteria for ESD. METHOD: Evaluation of gastrectomy specimens including LNM staging of patients submitted to gastrectomy for EGC in a 39-year retrospective cohort. A senior pathologist reviewed the histology slides. RESULTS: A total of 389 surgical specimens were included, of whose 135 met criteria for endoscopic resection. None of the 31 patients with classic criteria had LNM. Of the 104 patients with expanded criteria, 3 had LNM (n = 104, 2.9% CI 95% 0.7 - 8.6%), all of them with undifferentiated tumors without ulceration and less than 20 mm. In the patients with surgical criteria there were 50 LNM positive (n = 254; 19.7% CI 95% 15.3 - 25.1%). CONCLUSION: There is minimal risk of LNM in EGC when expanded criteria for ESD are met. This risk is practically nil for the classic criteria and when the undifferentiated tumor is excluded of the expanded criteria. Refinement of the expanded criteria for the risk of LNM may be desirable. Meanwhile the decision to complement the endoscopic treatment with LNM dissection or D2 gastrectomy will have to take into consideration the individual risk of perioperative morbidity and mortalit
CHARACTERIZATION OF THE MUCIN PHENOTYPE CAN PREDICT GASTRIC CANCER RECURRENCE AFTER ENDOSCOPIC MUCOSAL RESECTION
ABSTRACT BACKGROUND: Endoscopic mucosal resection is still considered an accepted treatment for early gastric cancer for selected cases. Histopathologic criteria for curative endoscopic resection are intramucosal well-differentiated adenocarcinoma, lateral and deep margins free of tumor, no histological ulceration, and no venous or lymphatic embolism. A 5% local recurrence rate has been described even when all the above-mentioned criteria are met. On the other hand, antigen expression by tumoral cells has been related to the biological behavior of several tumors. OBJECTIVE: To evaluate whether early gastric cancer mucin immunoexpression, p53 and Ki-67, can predict recurrence after endoscopic mucosal resection, even when standard histopathologic criteria for curative measures have been attempted. METHODS: Twenty-two patients with early gastric cancer were considered to have been completely resected by endoscopic mucosal resection. Local recurrence occurred in 5/22 (22.7%). Immunohistochemical study was possible in 18 (81.8%) resected specimens. Patients were divided in two groups: those with and those without local recurrence. They were compared across demographic, endoscopic, histologic data, and immunohistochemical factors for MUC2, MUC5a, CD10, p53, and Ki-67. RESULTS: Mucin immunoexpression allowed a reclassification of gastric adenocarcinoma in intestinal (10), gastric (2), mixed (4), and null phenotypes (2). Mixed phenotype (positive for both MUC2 and MUC5a) was found in 80% of cases in the local recurrence group, while the intestinal type (positive MUC2 and negative MUC5a) was found in 76.9% of cases without local recurrence (P=0.004). Other observed features did not correlate with neoplastic recurrence. CONCLUSION: The mixed phenotype of early gastric adenocarcinoma is associated with a higher probability of local recurrence after endoscopic mucosal resection
Validation of classic and expanded criteria for endoscopic submucosal dissection of early gastric cancer: 7 years of experience in a Western tertiary cancer center
OBJECTIVE: Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center. METHODS: We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisherâs exact test and chi-square tests, with 95% confidence intervals. RESULTS: In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (±11.7). The average procedure length was 113.9 minutes (±71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with âonly-by-sizeâ expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; ±14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014). CONCLUSION: These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries