Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2018; 10(10): 360-366
Published online Oct 15, 2018. doi: 10.4251/wjgo.v10.i10.360
Predictive factors for lymph node metastasis and defining a subgroup treatable for laparoscopic lymph node dissection after endoscopic submucosal dissection in poorly differentiated early gastric cancer
Hua Li, Zhi-Bin Huo, Fan-Ting Kong, Qing-Qiang He, Yun-He Gao, Wen-Quan Liang, Deng-Xiang Liu
Hua Li, Zhi-Bin Huo, Fan-Ting Kong, Qing-Qiang He, Department of Surgical Oncology, Xing Tai People Hospital, Xingtai 054001, Hebei Province, China
Yun-He Gao, Wen-Quan Liang, Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Deng-Xiang Liu, Institute of Cancer Control, Xing Tai People Hospital, Xingtai 054001, Hebei Province, China
Author contributions: Li H, Huo ZB and Fan-Ting Kong contributed equally to this work. Liu DX, Li H, designed the research; Li H, Huo ZB and Fan-Ting Kong analyzed the data and drafted the manuscript; He QQ revised the manuscript critically for important intellectual content and contributed to the data analysis; Gao YH and Liang WQ helped draft the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study is a retrospective study for the data of patients collected from the Department of Surgical Oncology, Affiliated Xing Tai People’s Hospital of Hebei Medical University during 1990-2015. No human body was involved in this study. In our hospital policy, this study does not require approval by the hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest was declared by the authors.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Deng-Xiang Liu, Academic Research, Chief Doctor, Surgical Oncologist, Institute of Cancer Control, Xing Tai People Hospital, No. 16 Hongxing Street, Xingtai 054001, Hebei Province, China.
Telephone: +86-319-3286153 Fax: +86-319-3286153
Received: July 3, 2018
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
Research background

For patients with poorly differentiated early gastric cancer (EGC), gastrectomy with lymphadenectomy is usually performed even though the gastric lesions can be completely removed with endoscopic submucosal dissection (ESD) due to the higher risk of lymph node metastasis (LNM). However, many surgical EGC cases actually do not have LNM, indicating that this surgery may not be necessary for many cases of EGC. To avoid this unnecessary surgery, the new technique combines ESD with laparoscopic lymph node dissection (LLND), which may lead to the elimination of unnecessary gastrectomy in poorly differentiated EGC patients having a potential risk of LNM.

Research motivation

We attempted to identify a subgroup of poorly differentiated EGC patients in whom the risk of LNM can be ruled out and treated them with ESD and LLND, which may serve as a breakthrough treatment for poorly differentiated EGC.

Research objectives

In this study, we intended to determine the risk factors that were predictive of LNM in poorly differentiated EGC patients and to provide some suggestions to guide the application of the combination of ESD and LLND for selected patients with poorly differentiated EGC.

Research methods

We retrospectively analyzed 138 patients with poorly differentiated EGC who underwent gastrectomy with lymphadenectomy (between January 1990 and December 2015). We also retrospectively analyzed (by univariate and multivariate logistic regression analyses) the association between the clinicopathological factors and the presence of LNM. We further examined the relationship between the positive number of the significant predictive factors and the LNM rate.

Research results

Tumor size, depth of invasion and lymphatic vessel involvement were found to be independently risk clinicopathological factors for LNM in poorly differentiated EGC. Furthermore, we established a simple criterion to expand the possibility of using ESD and LLND for the treatment of poorly differentiated EGC.

Research conclusions

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 lymphatic vessel involvement is absent upon postoperative histological examination. We found that the ESD with LLND may lead to the elimination of unnecessary gastrectomy in poorly differentiated EGC.

Research perspectives

The minimization of therapeutic invasiveness in order to preserve quality of life is a major topic in the management of EGC. One of the critical factors in choosing minimally invasive surgery for EGC would be the precise prediction of whether the patient has LNM. Therefore, in the future, we will carry out this retrospective study to determine the clinicopathological factors that are predictive of LNM in EGC and to guide the individual application of minimally invasive surgery in a suitable subgroup of patients with EGC.