Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.3996
Peer-review started: May 6, 2019
First decision: June 10, 2019
Revised: June 28, 2019
Accepted: July 5, 2019
Article in press: July 5, 2019
Published online: August 7, 2019
Processing time: 94 Days and 22.5 Hours
Endoscopic submucosal dissection (ESD) as a treatment for early gastric cancer (EGC) has been rapidly spreading. As ESD is now performed more frequently, noncurative resection after ESD is also becoming more frequent. It is controversial whether additional gastrectomy is necessary for all patients who do not meet the curative criteria after ESD.
It would be valuable to determine which factors could increase the risk of residual cancer (RC) or lymph node metastasis (LNM) in patients after noncurative ESD of EGC in order to avoid unnecessary surgery.
The objectives of this study were to identify the predictive factors for LNM and RC as well as to explore the appropriate strategy for treating those after non-curative ESD. We also aimed to assess the feasibility and safety of LG as additional surgery after ESD.
We analyzed the patients’ clinicopathological data and identified the predictors of RC and LNM.
Surgical specimens showed RC in ten patients and LNM in five. Multivariate analysis revealed that positive horizontal margin and neural invasion were independent risk factors for RC. Undifferentiated type was an independent risk factor for LNM. Tumors in all patients with LNM showed submucosal invasion more than 500 µm. Postoperative complications after additional laparoscopic gastrectomy occurred in five patients, and no deaths occurred among patients with complications.
Our study revealed that positive horizontal and neural invasion are independent risk factors for RC. Undifferentiated type is an independent risk factor for LNM. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD. Gastrectomy is necessary not only for patients who have a positive margin in ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 µm due to the risk of RC or LMN. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD.
A study of larger sample size is needed. Long-term outcomes of patients with noncurative ESD need to be investigated in a prospective multicenter trial.