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- Title
Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases.
- Authors
Sunagawa, Hideki; Kinoshita, Takahiro; Kaito, Akio; Shibasaki, Hidehito; Kaneko, Kazuhiro; Ochiai, Atsushi; Ohtsu, Atsushi; Nishida, Toshirou
- Abstract
Purpose: Endoscopic submucosal dissection is recommended for early gastric cancer with a low risk of lymph node metastasis. When the pathological findings do not meet the curative criteria; then, an additional gastrectomy with lymph node dissection is recommended. However, most cases have neither lymph node metastasis nor a local residual tumor during an additional surgery. Methods: This was a single-institutional retrospective cohort study, analyzing 200 patients who underwent an additional gastrectomy after non-curative endoscopic submucosal dissection from January 2005 to October 2015. We reviewed the patients' clinicopathological data and evaluated the predictors for the presence of a residual tumor. Results: Histopathology revealed lymph node metastasis in 15 patients (7.5 %) and a local residual tumor in 23 (11.5 %). A multivariable analysis revealed macroscopic findings (flat/elevated type) ( p = 0.011, odds ratio = 4.63), lymphatic invasion ( p < 0.0001, odds ratio = 14.2), and vascular invasion ( p = 0.04, odds ratio = 4.00) to be predictors for lymph node metastasis. A positive vertical margin ( p = 0.0027, odds ratio = 3.26) and horizontal margin ( p = 0.0008, odds ratio = 5.74) were predictors for a local residual tumor. All cases with lymph node metastasis had lymphovascular invasion with at least one other non-curative factor. Conclusions: The risk of a residual tumor can, therefore, be estimated based on the histopathology of endoscopic submucosal dissection samples. Lymphovascular invasion appears to be a pivotal predictor of lymph node metastasis.
- Subjects
GASTRECTOMY; HISTOPATHOLOGY; LYMPHATIC metastasis; LYMPH node cancer; GASTRIC mucosa; CANCER
- Publication
Surgery Today, 2017, Vol 47, Issue 2, p202
- ISSN
0941-1291
- Publication type
Article
- DOI
10.1007/s00595-016-1353-1