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Feasibility of Endoscopic Resection in Early Gastric Cancer with Lymphovascular Invasion

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Lymphovascular invasion (LVI) is associated with the risk of lymph node metastasis (LNM) and poor survival in gastric cancer patients; however, it is unclear whether LVI is a non-curative criteria component in all patients. We evaluated the risk factors of LNM in LVI-positive early gastric cancer (EGC) patients and identified a subgroup with a negligible LNM risk to assess the feasibility of endoscopic resection in these patients.

Methods

The clinicopathologic and survival data of patients undergoing surgery for gastric cancer were reviewed; LVI-positive EGC patients were selected. Logistic regression analysis was used to test the associations of potential risk factors with LNM, and Kaplan–Meier analysis was used to compare survival curves.

Results

LVI was detected in 1243 (15.5%) patients. In the multivariate logistic analysis, larger tumor size (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.16–1.31; p < 0.001), presence of ulcer (OR 1.80, 95% CI 1.15–2.82; p = 0.010), undifferentiated histology (OR 1.64, 95% CI 1.25–2.16; p < 0.001), submucosal invasion (OR 2.28, 95% CI 1.38–3.76; p = 0.001), middle (OR 2.12, 95% CI 1.26–3.55; p = 0.004) or lower third location (OR 2.28, 95% CI 1.32–3.60; p = 0.002), and younger age (OR 0.98, 95% CI 0.97–0.99; p = 0.002) independently predicted LNM in LVI-positive EGC patients. LVI-positive patients fulfilling the absolute endoscopic resection criteria did not have LNM and there was no significant difference in the overall (p = 0.928) and disease-specific survival (p = 0.821) between these patients and those with LVI-negative EGC.

Conclusions

Additional surgery after endoscopic resection might be unnecessary in LVI-positive patients meeting the absolute criteria for endoscopic resection.

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Authors and Affiliations

  1. Center for Health Promotion, Samsung Medical Center, Seoul, Korea

    Jeung Hui Pyo MD

  2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea

    Hyuk Lee MD, PhD, Yang Won Min MD, PhD, Byung-Hoon Min MD, PhD, Jun Haeng Lee MD, PhD & Jae J. Kim MD, PhD

  3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Kyoung-Mee Kim MD, PhD

  4. Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea

    Hyeseung Kim MS & Kyunga Kim PhD

Authors
  1. Jeung Hui Pyo MD
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  2. Hyuk Lee MD, PhD
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  3. Yang Won Min MD, PhD
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  4. Byung-Hoon Min MD, PhD
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  5. Jun Haeng Lee MD, PhD
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  6. Kyoung-Mee Kim MD, PhD
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  8. Kyunga Kim PhD
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  9. Jae J. Kim MD, PhD
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Correspondence to Hyuk Lee MD, PhD.

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Pyo, J.H., Lee, H., Min, Y.W. et al. Feasibility of Endoscopic Resection in Early Gastric Cancer with Lymphovascular Invasion. Ann Surg Oncol 26, 449–455 (2019). https://doi.org/10.1245/s10434-018-07119-4

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  • DOI: https://doi.org/10.1245/s10434-018-07119-4

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