{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T15:57:49Z","timestamp":1786550269675,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Despite improved outcomes for malignant tumors, evidence regarding the management of patients with multiple malignancies remains limited. We aimed to evaluate the clinical outcomes and prognosis of patients undergoing endoscopic submucosal dissection (<jats:styled-content style=\"fixed-case\">ESD<\/jats:styled-content>) for early gastric cancer (<jats:styled-content style=\"fixed-case\">EGC<\/jats:styled-content>) complicated by advanced malignancies in other organs with a poor prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>We retrospectively reviewed 3703 gastric cancer patients who underwent <jats:styled-content style=\"fixed-case\">ESD<\/jats:styled-content> at our hospital (2005\u20132022), focusing on those with advanced extra\u2010gastric malignancies with a 5\u2010year survival rate of &lt;\u200950%. <jats:styled-content style=\"fixed-case\">ESD<\/jats:styled-content> was performed for local tumor control based on patient preference when feasible, including lesions meeting standard, expanded, or relative indications where curative resection was unachievable. Clinicopathological characteristics and outcomes were analyzed. Twenty\u2010six patients met the inclusion criteria. En bloc resection was achieved in all cases (100%), with curative and non\u2010curative resection in 16 (62%) and 10 (38%) cases, respectively. None of the 10 patients with non\u2010curative resection exhibited lymphovascular invasion or <jats:styled-content style=\"fixed-case\">GC<\/jats:styled-content> recurrence. Complications included delayed bleeding, perforation, and pneumonia, each in one patient (4%), all leading to disseminated intravascular coagulation (<jats:styled-content style=\"fixed-case\">DIC<\/jats:styled-content>) and death within 30\u2009days post\u2010<jats:styled-content style=\"fixed-case\">ESD<\/jats:styled-content>. Notably, no complications were reported after 2010. Eleven patients died from advanced malignant tumors, with no <jats:styled-content style=\"fixed-case\">GC<\/jats:styled-content> recurrences observed during follow\u2010up in surviving patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Recently, no severe complications have been observed with <jats:styled-content style=\"fixed-case\">ESD<\/jats:styled-content>. Although <jats:styled-content style=\"fixed-case\">ESD<\/jats:styled-content> for local control in <jats:styled-content style=\"fixed-case\">EGC<\/jats:styled-content> with concurrent advanced extra\u2010gastric malignancies may be acceptable, the risk of severe complications, including <jats:styled-content style=\"fixed-case\">DIC<\/jats:styled-content>, remains. Therefore, careful patient selection and thorough informed consent are essential.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.70226","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T09:38:12Z","timestamp":1752572292000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3455-9257","authenticated-orcid":false,"given":"Hiroki","family":"Takemoto","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6369-0641","authenticated-orcid":false,"given":"Hidehiko","family":"Takigawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5638-3069","authenticated-orcid":false,"given":"Takahiro","family":"Kotachi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5448-2860","authenticated-orcid":false,"given":"Hajime","family":"Teshima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4154-658X","authenticated-orcid":false,"given":"Akiyoshi","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8048-8893","authenticated-orcid":false,"given":"Hidenori","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6494-8157","authenticated-orcid":false,"given":"Ken","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0942-1541","authenticated-orcid":false,"given":"Yuji","family":"Urabe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-1358","authenticated-orcid":false,"given":"Toshio","family":"Kuwai","sequence":"additional","affiliation":[{"name":"Gastrointestinal Endoscopy and Medicine Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1652-0743","authenticated-orcid":false,"given":"Shiro","family":"Oka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-018-00906-8"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504627"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-021-06437-w"},{"key":"e_1_2_10_5_1","first-page":"26","article-title":"Epidemiology of Gastric Cancer: Global Trends, Risk Factors and Prevention","volume":"14","author":"Rawla P.","year":"2019","journal-title":"Przeglad Gastroenterologiczny"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21262"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-016-4751-y"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1443-1661.2010.01062.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07455-z"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.47.5.618"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.4166\/kjg.2012.60.4.224"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-102650"},{"key":"e_1_2_10_13_1","first-page":"1358","article-title":"Multiple Primary Malignant Tumors. 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