• Surgical endoscopy · May 2015

    Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer.

    • Hyo-Joon Yang, Sang Gyun Kim, Joo Hyun Lim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim, Woo Ho Kim, and Hyun Chae Jung.
    • Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea.
    • Surg Endosc. 2015 May 1;29(5):1145-55.

    BackgroundAlthough surgery is recommend for non-curative endoscopic resection of early gastric cancer (EGC), only a part of patients are found to have lymph node (LN) metastasis. This study aimed to identify the predictors of LN metastasis in patients with non-curative endoscopic resection.MethodsBetween April 2005 and July 2013, consecutive patients who received non-curative endoscopic resection and then underwent gastrectomy with lymphadenectomy or followed at least 1 year with abdominal computed tomography were retrospectively enrolled at a single tertiary hospital. Non-curative resection was defined as a resection beyond the expanded criteria in pathologic mapping. The predictors for LN metastasis were identified by fitting a multivariate logistic regression model.ResultsAmong the 1783 consecutive patients who received endoscopic resection of EGC, non-curative resection was performed in 323 (18.1%) patients. Of these patients, a total of 267 patients were enrolled, and the rate of LN metastasis was 6.7% (18/267). In multivariate analysis, venous invasion [odds ratio (OR), 7.83; 95% confidence interval (CI) 2.20-27.86; p = 0.001], sm2 invasion (tumor invasion ≥500 µm into submucosa; OR 4.98; 95% CI 1.34-18.47; p = 0.016), or antral tumor location (OR 12.65; 95% CI 1.57-102.00; p = 0.017) were independent predictors for LN metastasis. The rates of LN metastasis were 1.1% (95% CI 0-2.7) for patients with one or no predictor and 17.8% (95% CI 9.7-25.8) for those with two or more predictors.ConclusionsAdditional gastrectomy with lymphadenectomy after non-curative endoscopic resection of EGC is recommended for the patients with two or more identified predictors. However, close follow-up without immediate surgery might be considered cautiously for those with only one or no predictor.

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