title: Extended indication of endoscopic resection for mucosal early gastric cancer: analysis of a single center experience.
abstract: BACKGROUND
  Endoscopic resection (ER) has become an important therapeutic option for early gastric cancer (EGC). Some investigators have suggested that this indication should be extended. We aimed to compare the extended indication of ER for intramucosal EGC based on data from a large, single-center study.
  
  
  METHODS
  We assessed lymph node metastasis (LNM) status in 1721 intramucosal EGC patients who underwent surgery to evaluate the potential of extension of the ER. We investigated LNM according to Japanese extended criteria; differentiated mucosal cancers irrespective of ulcer less than 30 mm (Criteria I); differentiated mucosal cancers without ulceration irrespective of tumor size (Criteria II), undifferentiated less than 20 mm without ulceration (Criteria III). We also tried to find the groups which have no and minimal risk of lymph node metastasis.
  
  
  RESULTS
  The rate of LNM of mucosal cancer was 2.6% (45/1721). There was minimal lymph nodal metastasis risk for criteria I (0.28%, 2/726, 95% Confidence Interval [CI], 0-0.66%), and criteria II (0.23%, 2/882, 95% CI, 0-0.54%). For criteria III, there was significant lymph node metastasis risk (1.15%, 3/261, 95% CI, 0-2.44%). There was no lymph node metastasis in differentiated mucosal cancer less than 20 mm irrespective of ulcer (0%, 0/501, 95% CI 0-0.73%). The differentiated mucosal cancer group irrespective of ulcer and tumor size have a minimal risk of metastasis (0.43%, 4/941, 95% CI, 0-0.84%)
  
  
  CONCLUSIONS
  Our data support extension of the ER indication for the differentiated mucosal EGC. However, undifferentiated lesions without ulceration and smaller than 20 mm were associated with significant metastasis.
authors.affiliation: Department of Internal Medicine, Gachon Graduate School of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Chung
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Jang
authors.forename: Young-Su
authors.initials: YS
authors.lastname: Park
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Yook
authors.forename: Sung Tae
authors.initials: ST
authors.lastname: Oh
authors.forename: Byung-Sik
authors.initials: BS
authors.lastname: Kim
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D002454:Cell Differentiation; D016009:Chi-Square Distribution; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome