Published online Oct 15, 2018. doi: 10.4251/wjgo.v10.i10.360
Peer-review started: July 3, 2018
First decision: July 11, 2018
Revised: August 24, 2018
Accepted: August 27, 2018
Article in press: August 28, 2018
Published online: October 15, 2018
To investigate the predictive factors of lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC); to guide the individual application of a combination of endoscopic submucosal dissection (ESD) and laparoscopic lymph node dissection (LLND) in a suitable subgroup of patients with poorly differentiated EGC.
We retrospectively analyzed 138 patients with poorly differentiated EGC who underwent gastrectomy with lymphadenectomy between January 1990 and December 2015. The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95% confidence interval (95%CI) were calculated. We further examined the relationship between the positive number of the significant predictive factors and the LNM rate.
The tumor diameter (OR = 13.438, 95%CI: 1.773-25.673, P = 0.029), lymphatic vessel involvement (LVI) (OR = 38.521, 95%CI: 1.975-68.212, P = 0.015) and depth of invasion (OR = 14.981, 95%CI: 1.617-52.844, P = 0.024) were found to be independent risk factors for LNM by multivariate analysis. For the 138 patients diagnosed with poorly differentiated EGC, 21 (15.2%) had LNM. For patients with one, two and three of the risk factors, the LNM rates were 7.7%, 47.6% and 64.3%, respectively. LNM was not found in 77 patients that did not have one or more of the three risk factors.
ESD might be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2 cm in size and when LVI is absent upon postoperative histological examination. ESD with LLND may lead to the elimination of unnecessary gastrectomy in poorly differentiated EGC.
Core tip: The new technique combines endoscopic submucosal dissection (ESD) with laparoscopic lymph node dissection (LLND), which may lead to the elimination of “unnecessary” gastrectomy in poorly differentiated early gastric cancer (EGC) patients that have a potential risk of lymph node metastasis (LNM). ESD followed by LLND enables the complete resection of the primary tumor and the histologic determination of the lymph node status. In this study, we determined the risk factors that were predictive of LNM in poorly differentiated EGC patients. Our results provided some suggestions to guide the application of combination of ESD and LLND for selected patients with poorly differentiated EGC.