Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis
ABSTRACT Aims Despite improved outcomes for malignant tumors, evidence regarding the management of patients with multiple malignancies remains limited. We aimed to evaluate the clinical outcomes and prognosis of patients undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC...
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Wiley
2025-07-01
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| Series: | JGH Open |
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| Online Access: | https://doi.org/10.1002/jgh3.70226 |
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| author | Hiroki Takemoto Hidehiko Takigawa Takahiro Kotachi Hajime Teshima Akiyoshi Tsuboi Hidenori Tanaka Ken Yamashita Yuji Urabe Toshio Kuwai Shiro Oka |
| author_facet | Hiroki Takemoto Hidehiko Takigawa Takahiro Kotachi Hajime Teshima Akiyoshi Tsuboi Hidenori Tanaka Ken Yamashita Yuji Urabe Toshio Kuwai Shiro Oka |
| author_sort | Hiroki Takemoto |
| collection | DOAJ |
| description | ABSTRACT Aims Despite improved outcomes for malignant tumors, evidence regarding the management of patients with multiple malignancies remains limited. We aimed to evaluate the clinical outcomes and prognosis of patients undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) complicated by advanced malignancies in other organs with a poor prognosis. Methods and Results We retrospectively reviewed 3703 gastric cancer patients who underwent ESD at our hospital (2005–2022), focusing on those with advanced extra‐gastric malignancies with a 5‐year survival rate of < 50%. ESD was performed for local tumor control based on patient preference when feasible, including lesions meeting standard, expanded, or relative indications where curative resection was unachievable. Clinicopathological characteristics and outcomes were analyzed. Twenty‐six patients met the inclusion criteria. En bloc resection was achieved in all cases (100%), with curative and non‐curative resection in 16 (62%) and 10 (38%) cases, respectively. None of the 10 patients with non‐curative resection exhibited lymphovascular invasion or GC recurrence. Complications included delayed bleeding, perforation, and pneumonia, each in one patient (4%), all leading to disseminated intravascular coagulation (DIC) and death within 30 days post‐ESD. Notably, no complications were reported after 2010. Eleven patients died from advanced malignant tumors, with no GC recurrences observed during follow‐up in surviving patients. Conclusions Recently, no severe complications have been observed with ESD. Although ESD for local control in EGC with concurrent advanced extra‐gastric malignancies may be acceptable, the risk of severe complications, including DIC, remains. Therefore, careful patient selection and thorough informed consent are essential. |
| format | Article |
| id | doaj-art-97f4a4655bca4c1785272fc77bd9071f |
| institution | Kabale University |
| issn | 2397-9070 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | JGH Open |
| spelling | doaj-art-97f4a4655bca4c1785272fc77bd9071f2025-08-20T03:32:11ZengWileyJGH Open2397-90702025-07-0197n/an/a10.1002/jgh3.70226Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor PrognosisHiroki Takemoto0Hidehiko Takigawa1Takahiro Kotachi2Hajime Teshima3Akiyoshi Tsuboi4Hidenori Tanaka5Ken Yamashita6Yuji Urabe7Toshio Kuwai8Shiro Oka9Department of Gastroenterology Hiroshima University Hospital Hiroshima JapanDepartment of Gastroenterology Hiroshima University Hospital Hiroshima JapanDepartment of Gastroenterology Hiroshima University Hospital Hiroshima JapanDepartment of Gastroenterology Hiroshima University Hospital Hiroshima JapanDepartment of Gastroenterology Hiroshima University Hospital Hiroshima JapanDepartment of Gastroenterology Hiroshima University Hospital Hiroshima JapanDepartment of Gastroenterology Hiroshima University Hospital Hiroshima JapanDepartment of Gastroenterology Hiroshima University Hospital Hiroshima JapanGastrointestinal Endoscopy and Medicine Hiroshima University Hospital Hiroshima JapanDepartment of Gastroenterology Hiroshima University Hospital Hiroshima JapanABSTRACT Aims Despite improved outcomes for malignant tumors, evidence regarding the management of patients with multiple malignancies remains limited. We aimed to evaluate the clinical outcomes and prognosis of patients undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) complicated by advanced malignancies in other organs with a poor prognosis. Methods and Results We retrospectively reviewed 3703 gastric cancer patients who underwent ESD at our hospital (2005–2022), focusing on those with advanced extra‐gastric malignancies with a 5‐year survival rate of < 50%. ESD was performed for local tumor control based on patient preference when feasible, including lesions meeting standard, expanded, or relative indications where curative resection was unachievable. Clinicopathological characteristics and outcomes were analyzed. Twenty‐six patients met the inclusion criteria. En bloc resection was achieved in all cases (100%), with curative and non‐curative resection in 16 (62%) and 10 (38%) cases, respectively. None of the 10 patients with non‐curative resection exhibited lymphovascular invasion or GC recurrence. Complications included delayed bleeding, perforation, and pneumonia, each in one patient (4%), all leading to disseminated intravascular coagulation (DIC) and death within 30 days post‐ESD. Notably, no complications were reported after 2010. Eleven patients died from advanced malignant tumors, with no GC recurrences observed during follow‐up in surviving patients. Conclusions Recently, no severe complications have been observed with ESD. Although ESD for local control in EGC with concurrent advanced extra‐gastric malignancies may be acceptable, the risk of severe complications, including DIC, remains. Therefore, careful patient selection and thorough informed consent are essential.https://doi.org/10.1002/jgh3.70226advanced malignant tumorearly gastric cancerendoscopic submucosal dissectionmultiple primary cancer |
| spellingShingle | Hiroki Takemoto Hidehiko Takigawa Takahiro Kotachi Hajime Teshima Akiyoshi Tsuboi Hidenori Tanaka Ken Yamashita Yuji Urabe Toshio Kuwai Shiro Oka Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis JGH Open advanced malignant tumor early gastric cancer endoscopic submucosal dissection multiple primary cancer |
| title | Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis |
| title_full | Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis |
| title_fullStr | Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis |
| title_full_unstemmed | Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis |
| title_short | Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis |
| title_sort | clinical outcomes of endoscopic submucosal dissection for early gastric cancer patients with concurrent advanced malignancies with expected poor prognosis |
| topic | advanced malignant tumor early gastric cancer endoscopic submucosal dissection multiple primary cancer |
| url | https://doi.org/10.1002/jgh3.70226 |
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