Abstract
Endoscopic resection for early gastric cancer (EGC) without lymph node metastasis may be a valuable treatment option. To date, endoscopic resection for undifferentiated EGC is being investigated. We evaluated the risk of lymph node metastasis in undifferentiated EGC by examining the preoperative endoscopic findings and operated pathologic specimen. The medical records of patients who underwent surgical resection because of undifferentiated EGC between November 2008 and December 2015 were reviewed retrospectively. The risk factors associated with lymph node metastasis and the lymph node metastasis rate in the expanded indication of undifferentiated EGC were evaluated. A total of 376 patients with undifferentiated EGC (233 signet ring cell type and 143 poorly differentiated type) were analyzed. Lymph node metastasis was found in 9.8% of the patients. Among the patients who met the expanded criteria (59 patients), only one patient had lymph node metastasis (signet ring cell type without ulceration and 15 mm in size). The risk factors associated with lymph node metastasis were lesion size >20 mm (OR 3.013), scar deformity (OR 2.248), surface depression (OR 2.360), submucosal invasion (OR 3.427), and lymphovascular invasion (OR 6.296). Before endoscopic resection of undifferentiated EGC, careful selection of patients should be considered. The undifferentiated EGC with size ≥15 mm, scar deformity, surface depression, submucosal invasion, and lymphovascular invasion should be considered surgical resection instead of endoscopic resection.
Highlights
Endoscopic resection for early gastric cancer (EGC) without lymph node metastasis may be a valuable treatment option
An endoscopic submucosal dissection (ESD) has been the standard treatment of EGC for a differentiated type without ulceration, of which is limited in the mucosa and 20 mm or less in size[2,3]
EGCs diagnosed as (1) differentiated type EGC > 20 mm without ulceration and lymphovascular invasion, (2) differentiated type EGC ≤ 30 mm with ulceration, and (3) undifferentiated type EGC ≤ 20 mm without ulceration and lymphovascular invasion were regarded as the expanded investigational indication for endoscopic resection[2,3]
Summary
Endoscopic resection for early gastric cancer (EGC) without lymph node metastasis may be a valuable treatment option. The undifferentiated EGC with size ≥15 mm, scar deformity, surface depression, submucosal invasion, and lymphovascular invasion should be considered surgical resection instead of endoscopic resection. Endoscopic resection for early gastric cancer (EGC) without lymph node metastasis may be a treatment of choice. Gotoda et al reported that the lymph node metastasis of undifferentiated EGCs 20 mm or less without associated ulcer formation and lymphovascular invasion was absent[6]. These lesions might be a candidate for endoscopic resection. The lymph node metastasis rate in the expanded criteria of undifferentiated type EGC was evaluated
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