Optimal extent of lymph node dissection in patients with gastric cancer who underwent non-curative endoscopic submucosal dissection with a positive vertical margin期刊界 All Journals 搜尽天下杂志传播学术成果专业期刊搜索期刊信息化学术搜索

按检索

Optimal extent of lymph node dissection in patients with gastric cancer who underwent non-curative endoscopic submucosal dissection with a positive vertical margin

Institution:	1. Division of Gastric Surgery, Shizuoka Cancer Center, Japan;2. Division of Pathology, Shizuoka Cancer Center, Japan;3. Clinical Research Center, Clinical Research Promotion Unit, Shizuoka Cancer Center, Japan;4. Division of Endoscopy, Shizuoka Cancer Center, Japan;1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;2. Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China;3. Department of Neurosurgery, Zhangzhou Hospital, Fujian Medical University, Fujian, China;1. Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran, Saudi Arabia;2. Department of Surgical Oncology, Cancer Institute in Montpellier, France;3. Moscow Research Oncological Institute n.a. P.A. Herzen, Thoracoabdominal, Moscow, Russian Federation;4. University of Tuebingen, Germany;5. Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy;6. National University Hospital, Singapore;7. QTI Comprehensive Cancer Center, Barcelona, Spain;8. CMC Volta, La Chaux-de-Fonds, Switzerland;9. Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Switzerland;10. Ghent University, Belgium;11. Université de Paris, UMR 1275 CAP Paris-Tech, F-75010, Paris, France;12. Service de Chirurgie Digestive et Cancérologie Hôpital Lariboisière, 2 rue Ambroise Paré, F-75010, Paris, France;3. General and Upper GI Surgery Division, University of Verona, Verona, Italy;4. Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy;5. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy;6. Oncologic and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy;7. Department of Gastroenterological, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy;8. Department of General and Emergency Surgery, University of Perugia, Perugia, Italy;9. Department of General Surgery, Ospedale Santa Croce e Carle of Cuneo, Cuneo, Italy;10. Oncologic Gastric and Peritoneal Surgery, Fondazione IRCCS Policlinico San Matteo of Pavia, Pavia, Italy;11. Department of Surgery, University of Pavia, Pavia, Italy;12. Department of Surgery, ASST Valle Olona, Gallarate, Varese, Italy;13. General Surgery, Liver Transplantation, AO Città della Salute e della Scienza of Turin, Italy;14. Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy;15. General Surgery Unit, Esine General Hospital, Department of Surgery, ASST Valcamonica, Esine, Brescia, Italy;p. Department of Surgery, Division of General Surgery, Fondazione Poliambulanza, Brescia, Italy;q. General Surgery, Vannini Hospital of Rome, Rome, Italy;r. Division of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy;s. Department of Surgery, General and Urgent Surgery Unit, Parini Regional Hospital of Aosta, Aosta, Italy;t. Department of General and Oncological Surgery, Ospedale Mauriziano of Turin, Turin, Italy;1. Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Turin, Italy;2. Department of Surgery, ASST Valle Olona, Gallarate, Varese, Italy;1. College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK;2. Manchester University NHS Foundation Trust, Wythenshawe, Manchester, M23 9LT, UK;3. University of Manchester, Manchester, M13 9PT, UK;4. Clinical Effectiveness Unit, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London, WC2A 3PE, UK;5. University of Southampton, Tremona Road, Southampton, SO16 6YD, UK;6. University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK;7. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, 69120, Heidelberg, Germany;8. Saarland Cancer Registry, Präsident Baltz-Straße 5, 66119, Saarbrücken, Germany;9. Nuffield Dept. of Population Health,University of Oxford, OX3 7LF, UK;7. Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) Consortium, United Kingdom;1. Department of Surgery, Guy''s & St Thomas'' Oesophago-gastric Centre, London, United Kingdom;2. Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK;3. Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) Consortium Cambridge, United Kingdom;4. Department of Histopathology, Guy''s & St Thomas'', London, United Kingdom;5. School of Cancer and Pharmaceutical Sciences, King''s College London, UK;6. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden

Abstract:	BackgroundThe optimal extent of lymph node dissection in patients receiving non-curative endoscopic submucosal dissection (ESD) and diagnosed with a positive vertical margin is unclear. This study attempted to identify optimal candidates for D2 lymph node dissection among these patients.MethodsThis study included patients who underwent gastrectomy for primary gastric cancer following non-curative ESD with a positive vertical margin between January 2002 and December 2018. We classified the patients according to the positive vertical margin pattern into an obvious exposure group and a non-obvious exposure group. We developed a score model for predicting lymph node metastasis (LNM) using factors selected by multivariate analyses and beta regression coefficients, and the incidence of LNM was evaluated.ResultsThis study included 110 patients. LNM was detected in 17 patients (15%). We developed a predictive scoring system as follows: tumor size >30 mm (0, No; 1, Yes) + undifferentiated type tumor in the invasive front (0, No; 2, Yes) + depth of submucosal invasion > 1500 μm (0, No; 1, Yes) + obvious tumor exposure at the vertical margin (0, No; 1, Yes). In patients with 5 points, the incidence rates of all and group 2 LNM were as high as 60% and 40%, respectively. Conversely, in patients with fewer than 5 points, the incidence rates of all and group 2 LNM were just 11% and 5%, respectively.ConclusionIn patients with 5 points according to our score model for predicting LNM, gastrectomy with D2 lymph node dissection is recommended.

Keywords:	Endoscopic submucosal dissection Positive vertical margin Obvious tumor cell exposure Horizontal exposure length ESD"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"endoscopic submucosal dissection LNM"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"lymph nodes metastasis IQR"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"interquartile range ROC"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"receiver operating characteristic AUC"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"area under the curve
本文献已被 ScienceDirect 等数据库收录！

设为首页 | 免责声明 | 关于勤云 | 加入收藏