Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2018; 10(10): 360-366
Published online Oct 15, 2018. doi: 10.4251/wjgo.v10.i10.360
Predictive factors for lymph node metastasis and defining a subgroup treatable for laparoscopic lymph node dissection after endoscopic submucosal dissection in poorly differentiated early gastric cancer
Hua Li, Zhi-Bin Huo, Fan-Ting Kong, Qing-Qiang He, Yun-He Gao, Wen-Quan Liang, Deng-Xiang Liu
Hua Li, Zhi-Bin Huo, Fan-Ting Kong, Qing-Qiang He, Department of Surgical Oncology, Xing Tai People Hospital, Xingtai 054001, Hebei Province, China
Yun-He Gao, Wen-Quan Liang, Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Deng-Xiang Liu, Institute of Cancer Control, Xing Tai People Hospital, Xingtai 054001, Hebei Province, China
Author contributions: Li H, Huo ZB and Fan-Ting Kong contributed equally to this work. Liu DX, Li H, designed the research; Li H, Huo ZB and Fan-Ting Kong analyzed the data and drafted the manuscript; He QQ revised the manuscript critically for important intellectual content and contributed to the data analysis; Gao YH and Liang WQ helped draft the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study is a retrospective study for the data of patients collected from the Department of Surgical Oncology, Affiliated Xing Tai People’s Hospital of Hebei Medical University during 1990-2015. No human body was involved in this study. In our hospital policy, this study does not require approval by the hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest was declared by the authors.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Deng-Xiang Liu, Academic Research, Chief Doctor, Surgical Oncologist, Institute of Cancer Control, Xing Tai People Hospital, No. 16 Hongxing Street, Xingtai 054001, Hebei Province, China. dengxianglfangliao@163.com
Telephone: +86-319-3286153 Fax: +86-319-3286153
Received: July 3, 2018
Peer-review started: July 3, 2018
First decision: July 11, 2018
Revised: August 24, 2018
Accepted: August 27, 2018
Article in press: August 28, 2018
Published online: October 15, 2018
Processing time: 104 Days and 12.4 Hours
Abstract
AIM

To investigate the predictive factors of lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC); to guide the individual application of a combination of endoscopic submucosal dissection (ESD) and laparoscopic lymph node dissection (LLND) in a suitable subgroup of patients with poorly differentiated EGC.

METHODS

We retrospectively analyzed 138 patients with poorly differentiated EGC who underwent gastrectomy with lymphadenectomy between January 1990 and December 2015. The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95% confidence interval (95%CI) were calculated. We further examined the relationship between the positive number of the significant predictive factors and the LNM rate.

RESULTS

The tumor diameter (OR = 13.438, 95%CI: 1.773-25.673, P = 0.029), lymphatic vessel involvement (LVI) (OR = 38.521, 95%CI: 1.975-68.212, P = 0.015) and depth of invasion (OR = 14.981, 95%CI: 1.617-52.844, P = 0.024) were found to be independent risk factors for LNM by multivariate analysis. For the 138 patients diagnosed with poorly differentiated EGC, 21 (15.2%) had LNM. For patients with one, two and three of the risk factors, the LNM rates were 7.7%, 47.6% and 64.3%, respectively. LNM was not found in 77 patients that did not have one or more of the three risk factors.

CONCLUSION

ESD might be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2 cm in size and when LVI is absent upon postoperative histological examination. ESD with LLND may lead to the elimination of unnecessary gastrectomy in poorly differentiated EGC.

Keywords: Poorly differentiated cancer; Laparoscopic lymph node dissection; Lymph node metastasis; Early gastric cancer; Endoscopic submucosal dissection

Core tip: The new technique combines endoscopic submucosal dissection (ESD) with laparoscopic lymph node dissection (LLND), which may lead to the elimination of “unnecessary” gastrectomy in poorly differentiated early gastric cancer (EGC) patients that have a potential risk of lymph node metastasis (LNM). ESD followed by LLND enables the complete resection of the primary tumor and the histologic determination of the lymph node status. In this study, we determined the risk factors that were predictive of LNM in poorly differentiated EGC patients. Our results provided some suggestions to guide the application of combination of ESD and LLND for selected patients with poorly differentiated EGC.