FERNANDA CRISTINA SIMOES PESSORRUSSO
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- Validation of classic and expanded criteria for endo-scopic submucosal dissection of early gastric cancer: 7 years of experience in a Western tertiary cancer center(2018) MENDONCA, Ernesto Quaresma; PESSORRUSSO, Fernanda Cristina Simoes; RAMOS, Marcus Fernando Kodama Pertille; JACOB, Carlos Eduardo; OLIVEIRA, Joel Fernandez de; RIBEIRO, Maria Sylvia; SAFATLE-RIBEIRO, Adriana; ZILBERSTEIN, Bruno; RIBEIRO JUNIOR, Ulysses; MALUF-FILHO, FauzeOBJECTIVE: Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center. METHODS: We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisher's exact test and chi-square tests, with 95% confidence intervals. RESULTS: In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (+/- 11.7). The average procedure length was 113.9 minutes (+/- 71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with ""only-by-size"" expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; +/- 14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014). CONCLUSION: These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries.
conferenceObject VALIDATION OF EXPANDED ENDOSCOPIC SUBMUCOSAL DISSECTION CRITERIA FOR TREATMENT OF EARLY GASTRIC ADENOCARCINOMA IN A WESTERN CENTER(2018) PESSORRUSSO, Fernanda C.; FELIPE-SILVA, Aloisio; JACOB, Carlos E.; RAMOS, Marcus F.; ZILBERSTEIN, Bruno; ALVES, Venancio A.; MELLO, Evandro S.; PEREIRA, Marina; CECCONELLO, Ivan; RIBEIRO, Ulysses; MALUF-FILHO, Fauze- Risk assessment of lymph node metastases in early gastric adenocarcinoma fulfilling expanded endoscopic resection criteria(2018) PESSORRUSSO, Fernanda Cristina Simoes; FELIPE-SILVA, Aloisio; JACOB, Carlos Eduardo; RAMOS, Marcus Fernando Kodama Pertille; FERREIRA, Venancio Avancini Alves; MELLO, Evandro Sobroza de; ZILBERSTEIN, Bruno; RIBEIRO JR., Ulysses; MALUF-FILHO, FauzeBackground and Aims: Early gastric cancer (EGC) is known to present a low rate of lymph node metastases (LNMs). Gastrectomy with D2 lymphadenectomy is usually curative for EGC. Endoscopic submucosal dissection (ESD) is a well-accepted treatment modality for lesions that meet the classic criteria: those mucosal differentiated adenocarcinoma measuring 20 mm or less, without ulceration. Expanded criteria for ESD have been proposed based on a null LNM rate from large gastrectomy series from Japan. Patients with LNM have been reported in Western centers, heightening the need for validation of expanded criteria. Our aim was to assess the risk of LNM in gastrectomy specimens of patients with EGC who met the expanded criteria for ESD. Methods: We conducted an evaluation of gastrectomy specimens including LNM staging of patients submitted to gastrectomy for EGC in a 39-year retrospective cohort. Results: A total of 389 surgical specimens were included. From them, 135 fulfilled criteria for endoscopic resection. None of the 31 patients with classic criteria had LNM. From the 104 patients with expanded criteria, 3 had LNM (n = 104 [2.9%], 95% confidence interval,.7%-8.6%), all of them with undifferentiated tumors without ulceration, measuring less than 20 mm. Conclusions: There is a small risk of LNM in EGC when expanded criteria for ESD are met. Refinement of the expanded criteria for the risk of LNM may be desirable in a Brazilian cohort. Meanwhile, the decision to complement the endoscopic treatment with gastrectomy will have to take into consideration the individual risk of perioperative morbidity and mortality.