Surgical endoscopy · 2026
Optimal timing of endoscopic submucosal dissection for gastric epithelial neoplasms: impact of preoperative waiting time on clinical outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Hoki Shinya, Yoshizaki Tetsuya, Ashizaki Risa, Higasa Yuta, Tanabe Hiroshi, Nishikawa Eri, Ishida Ryosuke, Hori Hitomi, Nakai Tatsuya, Ueda Chise, Shimamoto Yusaku, Urakami Satoshi, Abe Hirofumi, Takao Madoka, Takao Toshitatsu, Morita Yoshinori, Toyonaga Takashi, Kodama Yuzo
Аннотация
BACKGROUND: Endoscopic submucosal dissection (ESD) is considered the standard treatment for gastric epithelial neoplasms (GEN). However, the waiting time between the diagnosis of GEN and undergoing ESD varies among patients, and its effect on clinical outcomes remains to be elucidated. This study aimed to assess the impact of waiting time on clinical outcomes in patients undergoing ESD for GEN.
METHODS: This retrospective study included 797 patients with 994 lesions who underwent ESD for GEN between April 2013 and March 2018. Waiting time was defined as the period between endoscopic diagnosis and ESD. Patients were divided into two groups based on waiting time: < 90 days (short group) and ≥ 90 days (long group). The primary outcome was disease-specific survival, and secondary outcomes included overall survival, the cumulative incidence of metachronous GEN, and curative resection rates.
RESULTS: Prolonged waiting time was associated with ASA PS III and a preoperative histological diagnosis of non-cancer. Short-term outcomes were unaffected by waiting time. Specially, the odds of non-curative resection did not significantly change for 30-day increments in waiting time (OR 1.09; 95%CI 0.94-1.25; p = 0.25). Hazard function analysis suggested a visual upward trend in the risk of non-curative resection after 180 days. Long-term outcomes were unaffected by waiting time.
CONCLUSIONS: In conclusion, waiting times up to one year were not associated with clinical outcomes. A potential risk increase after 180 days was suggested visually but remained statistically inconclusive, serving only as an exploratory reference point.
METHODS: This retrospective study included 797 patients with 994 lesions who underwent ESD for GEN between April 2013 and March 2018. Waiting time was defined as the period between endoscopic diagnosis and ESD. Patients were divided into two groups based on waiting time: < 90 days (short group) and ≥ 90 days (long group). The primary outcome was disease-specific survival, and secondary outcomes included overall survival, the cumulative incidence of metachronous GEN, and curative resection rates.
RESULTS: Prolonged waiting time was associated with ASA PS III and a preoperative histological diagnosis of non-cancer. Short-term outcomes were unaffected by waiting time. Specially, the odds of non-curative resection did not significantly change for 30-day increments in waiting time (OR 1.09; 95%CI 0.94-1.25; p = 0.25). Hazard function analysis suggested a visual upward trend in the risk of non-curative resection after 180 days. Long-term outcomes were unaffected by waiting time.
CONCLUSIONS: In conclusion, waiting times up to one year were not associated with clinical outcomes. A potential risk increase after 180 days was suggested visually but remained statistically inconclusive, serving only as an exploratory reference point.