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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Editor-in-Chief
    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection

Hyo-Joon Yang1 , Wan-Sik Lee2 , Bong Eun Lee3 , Ji Yong Ahn4 , Jae-Young Jang5 , Joo Hyun Lim6 , Su Youn Nam7 , Jie-Hyun Kim8 , Byung-Hoon Min9 , Moon Kyung Joo10 , Jae Myung Park11 , Woon Geon Shin12 , Hang Lak Lee13 , Tae-Geun Gweon14 , Moo In Park15 , Jeongmin Choi16 , Chung Hyun Tae17 , Young-Il Kim18 , and Il Ju Choi18

1Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 2Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 3Department of Internal Medicine, Pusan National University School of Medicine, Busan, 4Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 5Department of Internal Medicine, Kyung Hee University College of Medicine, 6Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 7Division of Gastroenterology, Kyungpook National University Hospital and School of Medicine, Kyungpook National University, Daegu, 8Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 9Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 10Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 11Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 12Department of Internal Medicine, Hallym University College of Medicine, 13Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, 14Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, 15Department of Internal Medicine, Kosin University College of Medicine, Busan, 16Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 17Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, and 18Center for Gastric Cancer, National Cancer Center, Goyang, Korea

Correspondence to:Wan-Sik Lee
ORCID https://orcid.org/0000-0002-8021-6228
E-mail jadelook@hanmail.net
Bong Eun Lee
ORCID https://orcid.org/0000-0002-8021-6228
E-mail bongsul@daum.net

Received: September 15, 2020; Revised: November 18, 2020; Accepted: December 1, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut and Liver

Published online April 6, 2021

Copyright © Gut and Liver.

Abstract

Background/Aims: This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management.
Methods: From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46).
Results: No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality.
Conclusions: UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.

Keywords: Stomach neoplasms, Undifferentiated-type histology, Endoscopic mucosal resection, Margins of excision, Lymphatic metastasis


Article

ahead

Gut and Liver

Published online April 6, 2021

Copyright © Gut and Liver.

Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection

Hyo-Joon Yang1 , Wan-Sik Lee2 , Bong Eun Lee3 , Ji Yong Ahn4 , Jae-Young Jang5 , Joo Hyun Lim6 , Su Youn Nam7 , Jie-Hyun Kim8 , Byung-Hoon Min9 , Moon Kyung Joo10 , Jae Myung Park11 , Woon Geon Shin12 , Hang Lak Lee13 , Tae-Geun Gweon14 , Moo In Park15 , Jeongmin Choi16 , Chung Hyun Tae17 , Young-Il Kim18 , and Il Ju Choi18

1Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 2Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 3Department of Internal Medicine, Pusan National University School of Medicine, Busan, 4Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 5Department of Internal Medicine, Kyung Hee University College of Medicine, 6Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 7Division of Gastroenterology, Kyungpook National University Hospital and School of Medicine, Kyungpook National University, Daegu, 8Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 9Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 10Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 11Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 12Department of Internal Medicine, Hallym University College of Medicine, 13Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, 14Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, 15Department of Internal Medicine, Kosin University College of Medicine, Busan, 16Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 17Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, and 18Center for Gastric Cancer, National Cancer Center, Goyang, Korea

Correspondence to:Wan-Sik Lee
ORCID https://orcid.org/0000-0002-8021-6228
E-mail jadelook@hanmail.net
Bong Eun Lee
ORCID https://orcid.org/0000-0002-8021-6228
E-mail bongsul@daum.net

Received: September 15, 2020; Revised: November 18, 2020; Accepted: December 1, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims: This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management.
Methods: From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46).
Results: No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality.
Conclusions: UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.

Keywords: Stomach neoplasms, Undifferentiated-type histology, Endoscopic mucosal resection, Margins of excision, Lymphatic metastasis

Gut and Liver

Vol.15 No.3
May, 2021

pISSN 1976-2283
eISSN 2005-1212

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