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The role of tumor size in surgical decision making after endoscopic resection for early gastric cancer

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Abstract

Background

Endoscopic resection (ER) is curative treatment option for early gastric cancer (EGC). Additional surgery is required when the tumor pathology is beyond ER indication. It is unclear whether tumor size can be correlated with indications for surgery after ER. Therefore, we aimed to access the role of tumor size for surgical decision making after ER.

Methods

We reviewed clinicopathological data from 3246 patients underwent gastrectomy for EGC. The patients were classified into three groups as follows: the ulcer-negative intramucosal cancer with undifferentiated histology, ulcerative intramucosal cancer with differentiated histology, and minute submucosal (SM1) cancer with differentiated histology. The probability of additional surgery after ER was defined as at least one positive result for lymph node metastasis, lymphovascular invasion or perineural invasion. The probability was compared between individual tumor size and ER size criteria in each group using area under receiver operating characteristic curves.

Results

The probabilities of ulcer-negative intramucosal cancer with undifferentiated histology, SM1 cancer with differentiated histology and ulcerative intramucosal cancer with differentiated histology were 4.2, 22.1 and 2.5 %. In the ulcerative intramucosal cancer with differentiated histology group, these probabilities increased when the difference in tumor size was >1 mm compared with ER size criteria. The probability was not increased when there was a >10-mm tumor size difference compared with ER size criteria in the other two groups.

Conclusions

Tumor size was correlated with ER criteria in patients with ulcerative intramucosal cancer with differentiated histology after ER but was not strictly correlated with ER criteria in the other two patient groups. However, further study may be necessary to validate our results in the future.

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Acknowledgments

This work received approval by the Yonsei University College of Medicine Institutional Review Board on January 2013. This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012R1A1A1042417).

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    Authors and Affiliations

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

      Hae Won Kim, Yoo Jin Lee, Jie-Hyun Kim, Jae Jun Park, Young Hoon Youn & Hyojin Park

    2. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

      Jong Won Kim, Seung Ho Choi & Sung Hoon Noh

    3. Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

      Hae Won Kim, Yoo Jin Lee, Jie-Hyun Kim, Jae Jun Park, Young Hoon Youn, Hyojin Park, Jong Won Kim & Seung Ho Choi

    4. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea

      Jie-Hyun Kim

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    1. Hae Won Kim
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    Drs. Hae Won Kim, Yoo Jin Lee, Jie-Hyun Kim, Jae Jun Park, Young Hoon Youn, Hyojin Park, Jong Won Kim, Seung Ho Choi, Sung Hoon Noh have no conflict of interest or financial relationships relevant to this publication.

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    Hae Won Kim and Yoo Jin Lee have contributed equally to this work.

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    Kim, H.W., Lee, Y.J., Kim, JH. et al. The role of tumor size in surgical decision making after endoscopic resection for early gastric cancer. Surg Endosc 30, 2799–2803 (2016). https://doi.org/10.1007/s00464-015-4556-4

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    • DOI: https://doi.org/10.1007/s00464-015-4556-4

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