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Risk of lymph node metastasis in early gastric cancer and indications for endoscopic resection: is it worth applying the east rules to the west?

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Abstract

Background

Early gastric cancers are associated with lymph node metastasis (LNM) in 15% of cases. Risk factors for LNM are well established in Eastern countries. Less invasive treatments, such as endoscopic or surgical laparoscopic resection, are well accepted in Eastern countries and a matter of intense debate in the West, were indications for such treatments are still contested The objective of the study is to determine risk factors related to LNM and to validate endoscopic resection indications.

Methods

The study was a retrospective cohort of 178 patients with early gastric cancer who underwent gastrectomy. Clinical and pathological factors were analyzed. The new rules of ER from JGCA were applied to the studied cohort.

Results

LNM was present in 13.48% of the cases, 3.96% (3/76) in T1a tumors and 20.58% (21/102) in T1b tumors. In univariate analysis ulceration (p = 0.04), differentiation grade (p = 0.04), submucosal invasion (p = 0.001), lymphatic invasion (p < 0.001), and vascular invasion (p < 0.001) were associated with LNM. In multivariate analysis, differentiation grade (p = 0.005) and submucosal invasion (p = 0.005) were independent risk factors. One patient classified in the expanded criteria group and seven from the relative criteria group had LNM. There were no LNM for undifferentiated mucosal lesions without ulceration.

Conclusions

Undifferentiated tumors and submucosal invasion are risks factors associated with LNM in early gastric cancer in our study. Endoscopic Resection or less invasive and radical surgical treatments are an option to be carefully considered.

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Authors and Affiliations

  1. OncoVIDA Oncology Center – Surgical Oncology, Goiânia, GO, Brazil

    Leonardo Medeiros Milhomem & Orlando Milhomem da Mota

  2. Endoscopy Unit –Goiânia General Hospital (HGG), Goiânia, GO, Brazil

    Daniela Medeiros Milhomem-Cardoso

  3. Araújo Jorge Cancer Hospital - Associação de Combate ao Câncer em Goiás, Goiânia, GO, Brazil

    Eliane Duarte Mota, Alan Kagan & Jales Benevides Santana Filho

Authors
  1. Leonardo Medeiros Milhomem
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  2. Daniela Medeiros Milhomem-Cardoso
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  3. Orlando Milhomem da Mota
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  4. Eliane Duarte Mota
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  6. Jales Benevides Santana Filho
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Correspondence to Daniela Medeiros Milhomem-Cardoso.

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Disclosures

Dr Daniela Medeiros Milhomem-Cardoso is a Master Consulting for Olympus Optical Corporation and is on the speaker´s bureau of Olympus. There are no funding ties to disclosure related to the present study. Drs Leonardo medeiros Milhomem, Orlando Milhomem da Mota, Eliane Duarte Mota, Alan Kagan, and Jales Benevides Santana Filho have no conflicts of interest and no financial ties to disclosure.

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Milhomem, L.M., Milhomem-Cardoso, D.M., da Mota, O.M. et al. Risk of lymph node metastasis in early gastric cancer and indications for endoscopic resection: is it worth applying the east rules to the west?. Surg Endosc 35, 4380–4388 (2021). https://doi.org/10.1007/s00464-020-07932-7

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  • DOI: https://doi.org/10.1007/s00464-020-07932-7

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