Evidence map›Paper›PMID 27098174›Full record

ArticleJournal of gastroenterology2017

Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multi-center retrospective study in Japan.

Waku Hatta, Takuji Gotoda, Tsuneo Oyama, Noboru Kawata, Akiko Takahashi, Yoshikazu Yoshifuku, Shu Hoteya, Koki Nakamura, Masaaki Hirano, Mitsuru Esaki and 13 more

Abstract readComparative StudyMulticenter Study
PubMed Publisher
In one paragraph

Article in Journal of gastroenterology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
89citing papers in PubMed, 6 pooled it
13.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

89 citing papers in PubMed, 6 syntheses or guidelines pooled it, 137 citations in OpenAlex.

  1. Guideline
  2. Pooled it
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  4. [Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer].The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · 2020
    Guideline
  5. Pooled it
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  7. Trial
  8. Randomized controlled trial of uncut Roux-en-YWorld journal of gastroenterology · 2017
    Trial
  9. External validation and comparison of five prediction models for lymph node metastasis after noncurative endoscopic submucosal dissection for early gastric cancer.Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
    Article
  10. Review
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  16. Endoscopic Diagnosis of Remnant Gastric Cancer After Gastrectomy.The Korean journal of helicobacter and upper gastrointestinal research · 2025
    Review
  17. Article
  18. Article
  19. Article
  20. Article

29 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors at 20 institutions in 1 country.

Waku HattaDepartment of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. waku-style@festa.ocn.ne.jp.
Takuji GotodaDivision of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
Tsuneo OyamaDivision of Endoscopy, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 385-0051, Japan.
Noboru KawataDivision of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Akiko TakahashiDivision of Endoscopy, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 385-0051, Japan.
Yoshikazu YoshifukuDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
Shu HoteyaDepartment of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
Koki NakamuraDepartment of Internal Medicine, Hiroshima City Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan.
Masaaki HiranoDepartment of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu, Niigata, 943-0192, Japan.
Mitsuru EsakiDepartment of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan.
Mitsuru MatsudaDepartment of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nisinagae, Toyama, Toyama, 930-8550, Japan.
Ken OhnitaDepartment of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 952-8501, Japan.
Ryo ShimodaDepartment of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan.
Motoyuki YoshidaDepartment of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
Osamu DohiDepartment of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan.
Jun TakadaDepartment of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
Keiko TanakaDepartment of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
Shinya YamadaDepartment of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, Kyoto, 605-0981, Japan.
Tsuyotoshi TsujiDepartment of Gastroenterology, Akita City Hospital, 4-30 Matsuoka-machi, Kawamoto, Akita, Akita, 010-0933, Japan.
Hirotaka ItoDepartment of Gastroenterology, Osaki Citizen Hospital, 3-8-1 Honami, Furukawa, Osaki, Miyagi, 989-6183, Japan.
Yoshiaki HayashiDivision of Gastroenterology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, Fukui, 910-8526, Japan.
Tomohiro NakamuraDepartment of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan.
Tooru ShimosegawaDepartment of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Saku Central Hospital · JPTohoku University · JPAkita University Hospital · JPFukui Prefectural Hospital · JPGifu University · JPHiroshima Prefectural Hospital · JPHiroshima University · JPJapanese Red Cross Society Kyoto Daini Hospital · JPKitakyushu Municipal Medical Center · JPKyoto Prefectural University of Medicine · JPNagasaki University Hospital · JPNara Medical University · JPNihon University · JPNiigata Prefectural Central Hospital · JPOsaki Citizen Hospital · JPShinshu University · JPShizuoka Cancer Center · JPTohoku Medical Megabank Organization · JPToranomon Hospital · JPToyama Prefectural Central Hospital · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough radical surgery is routinely performed for patients who do not meet the curative criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) due to the risk of lymph node metastasis (LNM), this standard therapeutic option may be excessive given the lower number of patients with LNM. Therefore, we aimed to investigate long-term outcomes and validate risk factors predicting recurrence after ESD.

methodsOf 15,785 patients who underwent ESD for EGC at 19 institutions between 2000 and 2011, 1969 patients not meeting the curative criteria were included in this multi-center study. Based on the treatment strategy after ESD, patients were divided into radical surgery (n = 1064) and follow-up (no additional treatment, n = 905) groups.

resultsOverall survival (OS) and disease-specific survival (DSS) were significantly higher in the radical surgery group than in the follow-up group (p < 0.001 and p = 0.012, respectively). However, the difference in 3-year DSS between the groups (99.4 vs. 98.7 %) was rather small compared with the difference in 3-year OS (96.7 vs. 84.0 %). LNM was found in 89 patients (8.4 %) in the radical surgery group. Lymphatic invasion was found to be an independent risk factor for recurrence in the follow-up group (hazard ratio 5.23; 95 % confidence interval 2.01-13.6; p = 0.001).

conclusionsThis multi-center study, representing the largest cohort to date, revealed a large discrepancy between OS and DSS in the two groups. Since follow-up with no additional treatment after ESD may be an acceptable option for patients at low risk, further risk stratification is needed for appropriate individualized treatment strategies.

Indexed as

AgedAged, 80 and overEndoscopic Mucosal ResectionFemaleFollow-Up StudiesHumansJapanLymphatic MetastasisMaleMiddle AgedNeoplasm Recurrence, LocalRetrospective StudiesRisk FactorsStomach NeoplasmsSurvival RateTreatment OutcomeEarly gastric cancerEndoscopic submucosal dissectionFollow-upLymphatic invasionRadical surgery

Identifiers

PMID27098174
OpenAlexW2338803898

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.