ONCOLOGIC SAFETY OF DELAYED SURGERY AFTER NON-CURATIVE ENDOSCOPIC RESECTION IN PATIENTS WITH EARLY GASTRIC CANCER
Ji Eun Na*, Hyuk Lee, Tae Jun Kim, Yang Won Min, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim
Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
Background and aims When non-curative resection is confirmed after endoscopic resection of early gastric cancer, delayed curative gastrectomy is recommended because of the risk of lymph node metastasis. We aimed to compare long-term survival and lymph node metastasis after delayed (secondary) and primary surgery.
Methods Patients who underwent R0 curative gastrectomy for early gastric cancer were included and divided into primary surgery and secondary surgery for non-curative resection after endoscopic resection groups. Propensity score matching of the two groups (3:1) was performed. The primary outcome was 5-year overall survival and the secondary outcomes were 5-year cancer specific survival, 5-year disease free survival, and lymph node metastasis rate.
Results A total of 6,512 patients were included, 6,111 (93.8%) in the primary surgery group and 401 (6.2%) in the secondary surgery group. After propensity score matching, 1,439 patients were included in the analysis, 1042 (72.41%) in the primary surgery group and 397 (27.59%) in the secondary surgery group. The 5-year overall (HR, 0.608; 95% CI, 0.314-1.176; p = 0.139) and disease-free survival rates (HR, 0.256; 95% CI, 0.06 to 1.095; p = 0.066) were equivalent in the two groups. The lymph node metastasis rate (HR, 0.423; 95% CI, 0.244 to 0.731; p = 0.002) was higher and the 5-year cancer specific survival (HR, 0.039; 95% CI, 0.018-0.902; p = 0.039) was more unfavorable in the primary surgery group.
Conclusions The long-term outcomes of secondary surgery after non-curative endoscopic resection for early gastric cancer were non-inferior to primary surgery in terms of 5-year survival and lymph node metastasis risk.
Back to 2020 Abstracts