title: Endoscopic submucosal dissection as a staging measure may not lead to worse prognosis in early gastric cancer patients with additional gastrectomy.
abstract: BACKGROUND
  Endoscopic submucosal dissection is a novel endoluminal technique that enables resection of early stage gastrointestinal malignancies in an en bloc fashion.
  
  
  OBJECTIVE
  To assess whether preceding endoscopic submucosal dissection affected the prognoses of patients who underwent additional gastrectomy with lymph node dissection due to suspicion of nodal metastasis from endoscopic submucosal dissection specimens.
  
  
  METHODS
  Thirty-one patients with early gastric cancer who underwent gastrectomy after endoscopic submucosal dissection were retrospectively investigated in terms of their survival and tumour recurrence. Additional gastrectomy was performed when histology of the endoscopic submucosal dissection specimens revealed that the tumours did not meet the criteria for node-negative cancers.
  
  
  RESULTS
  Twenty-three (74%) and eight (26%) patients had undergone endoscopic submucosal dissection previously due to clinical diagnoses of node-negative cancers and possible node-positive cancers, respectively. Histology of the resected stomachs and lymph nodes revealed residual carcinoma of the stomach in two (6.5%) patients and nodal metastases in four (13%) patients. All patients remain alive without recurrence (median follow-up, 3.4 years; range, 0.6-5.2 years).
  
  
  CONCLUSIONS
  Based on the histology of endoscopic submucosal dissection specimens, preceding endoscopic submucosal dissection itself had no negative influence on a patient's prognosis when additional gastrectomy was performed. It may be permissible to resect some early gastric cancers by endoscopic submucosal dissection as a first step to prevent unnecessary gastrectomy, if technically resectable.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Goto
authors.forename: M
authors.initials: M
authors.lastname: Fujishiro
authors.forename: N
authors.initials: N
authors.lastname: Kakushima
authors.forename: S
authors.initials: S
authors.lastname: Kodashima
authors.forename: S
authors.initials: S
authors.lastname: Ono
authors.forename: H
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: S
authors.initials: S
authors.lastname: Nomura
authors.forename: M
authors.initials: M
authors.lastname: Kaminishi
authors.forename: M
authors.initials: M
authors.lastname: Omata
mesh_terms: D000368:Aged; D004210:Dissection; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*