Management of early gastric cancer that meet the indication for radical lymph node dissection following endoscopic resection: a retrospective cohort analysis

BMC Surg. 2017 Jun 20;17(1):72. doi: 10.1186/s12893-017-0268-0.

Abstract

Background: Endoscopic resection (ER) has been widely accepted as the standard treatment for early gastric cancer (EGC). However, in patients considered to have undergone non-curative ER due to their potential risk of lymph node metastasis (LNM), additional gastrectomy is recommended. The aim of the present study was to identify EGC patients after non-curative ER at high risk of LNM.

Methods: A total of 150 patients who had undergone ER for EGC were diagnosed as non-curative ER due to their potential risk of LNM. Clinicopathological data and clinical outcomes were examined retrospectively.

Results: Additional gastrectomy with lymph node dissection was performed in 73 patients, and the remaining 77 patients were followed-up without additional gastrectomy. In patients who underwent additional gastrectomy, 8 patients had local residual tumor, and 8 patients had LNM, which were limited in the peritumoral nodes. Only lymphatic invasion (p = 0.012) was a statistically significant factor for LNM. The 5-year overall survival and recurrence-free survival were not significantly different between patients with and without additional gastrectomy.

Conclusion: Additional gastrectomy with lymph node dissection is recommended for patients who were diagnosed as non-curative ER with lymphatic invasion, and minimizing the extent of lymph node dissection may be allowed for these patients.

Keywords: Early gastric cancer; Endoscopic resection; Lymph node metastasis.

MeSH terms

  • Aged
  • Cohort Studies
  • Early Detection of Cancer
  • Endoscopy / methods*
  • Female
  • Gastrectomy / methods*
  • Humans
  • Lymph Node Excision
  • Lymphatic Metastasis
  • Male
  • Retrospective Studies
  • Stomach Neoplasms / surgery*