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Preoperative predictors of beyond endoscopic submucosal dissection indication or lymphovascular invasion in endoscopic resection for early gastric cancer

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Abstract

Background

To successfully resect early gastric cancer (EGC), prediction of lymph node metastasis is essential. Beyond endoscopic submucosal dissection (ESD) indication or lymphovascular invasion (LVI) are known risk factors associated with lymph node metastasis. However, accurate prediction of tumor invasion depth or LVI is impossible before endoscopic resection even when endoscopic ultrasound is used. The aim of this study was to identify the predictive factors associated with beyond ESD indication or LVI after ESD for EGC.

Methods

Between Jan 2011 and Feb 2015, 532 lesions from 506 patients who received ESD for EGCs were included. We reviewed the data of patients diagnosed as EGCs without ulceration or those smaller than 3 cm with ulceration.

Results

The incidence of EGCs found to be beyond expanded ESD indications or present of LVI after ESD was 11.1% (59/532). On multivariable analysis, endoscopic features of SM invasion, surface color changes, and elevated lesions were associated with beyond ESD indication or LVI. In particular, submucosal (SM) invasive features such as SM tumor-like marginal elevation [odds ratio (OR) 17.2; 95% confidence interval (CI) 2.0–146.7], fusion of convergent folds (OR 12.9; 95% CI 3.9–42.1), irregular surface (OR 17.8; 95% CI 5.6–56.8), and discoloration of the tumor surface (OR 16.1; 95% CI 2.4–105.9) were significant risk factors for beyond ESD indication or LVI.

Conclusions

The decision to proceed with endoscopic resection for EGCs with endoscopic features of SM invasion, surface color changes, or elevated forms must be made cautiously.

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Authors and Affiliations

  1. Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea

    Su Jin Kim, Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Hyeong Seok Nam & Dae Gon Ryu

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  1. Su Jin Kim
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  2. Cheol Woong Choi
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Correspondence to Cheol Woong Choi.

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Su Jin Kim, Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Hyeong Seok Nam, and Dae Gon Ryu have no conflicts of interest or financial ties to disclose.

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Kim, S.J., Choi, C.W., Kang, D.H. et al. Preoperative predictors of beyond endoscopic submucosal dissection indication or lymphovascular invasion in endoscopic resection for early gastric cancer. Surg Endosc 32, 2948–2957 (2018). https://doi.org/10.1007/s00464-017-6009-8

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  • DOI: https://doi.org/10.1007/s00464-017-6009-8

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