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Predictive factors for lymph node metastasis in additional gastrectomy after endoscopic resection of cT1aN0 gastric cancer

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Abstract

Purpose

Endoscopic therapy for clinical T1aN0 (cT1aN0) gastric cancer is an excellent therapeutic strategy; however, pathological lymph node metastasis (LNM) occasionally occurs. Patients who have a potential for LNM are subject to additional gastrectomy. Our aim was to identify predictors of LNM in additional gastrectomy.

Methods

One hundred and twelve cT1aN0 gastric cancer patients undergoing additional gastrectomy after endoscopic resection were identified between 1997 and 2013. Predictors for LNM were initially selected by a univariate analysis and applied to a multivariate analysis.

Results

(1) Twelve patients (10.7 %) had LNM following additional gastrectomy. (2) Clinicopathological factors significantly associated with LNM were the depth of invasion (SM2 or deeper, designated as SM2) (p = 0.0018) and rigorous lymphatic invasion (ly2,3) (p < 0.001). (3) The univariate predictors for LNM were applied to the multivariate logistic regression model, and SM2 (p = 0.0027) and ly2,3 (p = 0.0028) remained significant predictors. (4) When classified into 2 × 2 subgroups, the predictability for LNM was as follows: SM2 plus ly2,3 (46.7 %), SM2 plus ly0,1 (10.0 %), M,SM1 plus ly2,3 (0 %), and M,SM1 plus ly0,1 (0 %).

Conclusions

In cT1aN0 gastric cancer patients, both SM2 and ly2,3 are significant predictors for LNM that may be important as references for additional gastrectomy after endoscopic resection.

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Authors and Affiliations

  1. Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Satoru Ishii, Keishi Yamashita, Hiroshi Kato, Nobuyuki Nishizawa, Hideki Ushiku, Hiroaki Mieno, Hiromitu Moriya, Kei Hosoda, Natuya Katada, Shiro Kikuchi & Masahiko Watanabe

  2. Department of Gastroenterology, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Japan

    Satoshi Tanabe & Wasaburo Koizumi

  3. Department of Pathology, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Japan

    Makoto Saegusa

Authors
  1. Satoru Ishii
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  2. Keishi Yamashita
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  3. Hiroshi Kato
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  4. Nobuyuki Nishizawa
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  14. Masahiko Watanabe
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Correspondence to Masahiko Watanabe.

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Ishii, S., Yamashita, K., Kato, H. et al. Predictive factors for lymph node metastasis in additional gastrectomy after endoscopic resection of cT1aN0 gastric cancer. Surg Today 46, 1031–1038 (2016). https://doi.org/10.1007/s00595-015-1281-5

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  • DOI: https://doi.org/10.1007/s00595-015-1281-5

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