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Endoscopic submucosal dissection (ESD) is a primary treatment for gastric malignancies. However, ulcerative early gastric cancer often poses unique pathological challenges. These characteristics can frequently lead to non-curative resection (NCR). Additionally, such cases involve a higher risk of metachronous gastric cancer (MGC). Consequently, understanding specific risk factors is essential for clinicians.
The study analyzed 182 patients. Specifically, multivariate logistic regression identified two independent risk factors for NCR. First, a lesion size between 20 and 30 mm significantly increases risk. Second, an undifferentiated histologic type on preoperative biopsy predicts poor outcomes. Moreover, these findings suggest that precise preoperative assessments are crucial.
Patients must also face the possibility of metachronous lesions. Specifically, multivariate Cox regression identified older age as a major concern. Furthermore, indistinct ulcer margins significantly correlate with MGC development. Therefore, clinicians should prioritize intensive surveillance for patients over 65. Similarly, those with unclear ulcer borders need careful monitoring.
In conclusion, the study emphasizes the need for tailored therapeutic strategies. Because specific factors predict NCR and MGC, preoperative evaluation must be thorough. Consequently, clinicians can optimize outcomes through better risk stratification. Ultimately, long-term surveillance remains the gold standard for high-risk patients.
The main risk factors identified include a lesion size of 20-30 mm and an undifferentiated histologic type determined during preoperative biopsy.
Patients aged 65 years or older have a significantly increased risk of developing metachronous cancer following an ESD procedure.
Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Refer to the latest local and national guidelines for clinical practice.
References
1. Xin Y et al. Risk factors associated with non-curative resection and metachronous cancer after endoscopic submucosal dissection in patients with ulcerative early gastric cancer. Eur J Med Res. 2026 Feb 24. doi: 10.1186/s40001-026-03961-5. PMID: 41736131.
2. Kim JH, Kim SG, Chung H, et al. Risk factors for metachronous recurrence after endoscopic submucosal dissection of early gastric cancer. World J Gastroenterol. 2018;24(25):2713-2722. doi:10.3748/wjg.v24.i25.2713.
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