title: Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines.
abstract: BACKGROUND
  Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely performed. Indications for these procedures have been extended in Korea and Japan. The aim was to evaluate whether these extended indications are safe.
  
  
  METHODS
  All patients who had surgery for early gastric cancer at Seoul National University Bundang Hospital between May 2003 and December 2007 were identified from a prospective database. Lymph node status was examined in patients who met extended indications for EMR and had undergone surgical resection.
  
  
  RESULTS
  Of patients with mucosal cancers, 129 met extended indications for EMR or ESD and three (2.3 per cent) had lymph node metastasis. Of the 52 submucosal cancers meeting extended indications for EMR or ESD, two (4 per cent) had lymph node metastasis. Differentiated mucosal cancers without ulcer formation did not have lymph node metastasis, irrespective of size.
  
  
  CONCLUSIONS
  Extending the indications for EMR and ESD according to the Japanese Gastric Cancer Association guidelines carries an increased risk of lymph node metastasis. For cancers meeting these criteria, treatment by gastric resection with lymph node dissection should still be considered. A well differentiated mucosal cancer of any size without ulceration may be considered as an extended indication for EMR or ESD.
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Jee
authors.forename: S-H
authors.initials: SH
authors.lastname: Hwang
authors.forename: J
authors.initials: J
authors.lastname: Rao
authors.forename: D J
authors.initials: DJ
authors.lastname: Park
authors.forename: H-H
authors.initials: HH
authors.lastname: Kim
authors.forename: H-J
authors.initials: HJ
authors.lastname: Lee
authors.forename: H-K
authors.initials: HK
authors.lastname: Yang
authors.forename: K U
authors.initials: KU
authors.lastname: Lee
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D007564:Japan; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*