A systematic review and meta-analysis on outcomes after Rx or R1 endoscopic resection of superficial gastric cancer

• Type: Another Publication in an International Scientific Journal
• Date: 2015

Authors

Figueiredo, PC (Author) Other; Pedro Pimentel-Nunes (Author) FMUP; Libanio, D (Author) Other; Mario Dinis Ribeiro (Author) FMUP

Journal

Title: European Journal of Gastroenterology & Hepatology

Vol. 27

Pages: 1249-1258

ISSN: 0954-691X

Publisher: Lippincott Williams & Wilkins

Indexing

ISI Web of Knowledge - 5 Citations

Scopus - 7 Citations

Other information

Authenticus ID: P-00G-PAJ

DOI: 10.1097/meg.0000000000000440

Abstract (EN): Objective Endoscopic resection is a standard treatment for gastric superficial lesions. A positive or a nonevaluable margin is considered a noncurative criterion. We aimed to systematically review recurrence, residual disease, lymph node metastasis (LNM) and cancer-related death following Rx/R1 resection of gastric lesions in the absence of other noncurative criteria. Materials and methods MEDLINE systematic review and meta-analysis by July 2014. Results Data were extracted from 31 manuscripts. Definitions and results differed significantly. However, nonevaluable (HMx) and positive horizontal margins (HM1) were associated with 10% [95% confidence interval (CI) 5-15%] and 36% (95% CI 24-48%) rates of recurrence/residual disease, respectively, with an odds ratio of 2.85 (95% CI 1.6-5.8, P < 0.01) for HM1 compared with HMx. Nonevaluable (VMx) or positive (VM1) vertical margin was associated with a 43% (95% CI 17-68%) rate of recurrence/residual. VMx/VM1 was associated with a higher risk of recurrence/residual compared with HMx/HM1 (odds ratio 3.76, 95% CI 1.71-6.82, P < 0.01). The most common strategy after HMx/HM1 was endoscopic surveillance and retreatment, whereas surgery was recommended after VMx/VM1. No cases of LNM or cancer-related death were noticeable if neither submucosal invasion more than 500 mu m nor lymphovascular infiltration was also reported. Conclusion Rx/R1 resection in the absence of other noncurative criteria does not appear to be a significant risk factor for LNM or cancer-related death. The risk of recurrence/residual disease is higher after HM1 than HMx and higher after VMx/VM1 than HMx/HM1. However, considerable heterogeneity was found in studies. Standard definitions should be created and applied in future studies. Copyright

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 10