title: Surgical resection for mucosal gastric cancer in the era of endoscopic submucosal dissection.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) has been widely performed. The spread of ESD might decrease the rate of gastrectomy for mucosal gastric cancer. However, the rate of patients with lymph node metastasis (LNM) might increase, because patients with mucosal gastric cancer who had no or a lower risk of LNM underwent ESD instead of gastrectomy. The purpose of the present study was to determine the incidence of LNM and analyze the relationships between LNM and clinicopathological findings of mucosal gastric cancers that are included among the extra indications for ESD.
  
  
  METHODS
  Three-hundred sixty patients with pathologically diagnosed as mucosal gastric cancer who underwent gastrectomy between September 2002 and April 2009 were analyzed.
  
  
  RESULTS
  Of 360 patients with pathologically diagnosed mucosal gastric cancer, 34 had initially undergone ESD. Before initial treatment, 202 patients (56.1%) were diagnosed as having mucosal cancer, and lymph node involvement was observed in 23 patients (6.4%). Female sex, ulcerative lesion, and lymphatic-vascular invasion had a significant association with LNM by univariate analysis. All 23 patients with LNM had a macroscopically depressed lesion. When the possible indicators of LNM were entered into the multivariate logistic regression analysis, female sex and lymphatic-vascular invasion were significantly correlated with LNM.
  
  
  CONCLUSIONS
  In cases in which the tumor is macroscopically depressed and the histological diagnosis from ESD reveals lymphatic-vascular invasion, standard D2 or D1+beta lymphadenectomy should be performed because of the high incidence of LNM.
authors: Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan. y.tanizawa@scchr.jp
authors: Yutaka
authors: Y
authors: Tanizawa
authors: Etsuro
authors: E
authors: Bando
authors: Taiichi
authors: T
authors: Kawamura
authors: Masanori
authors: M
authors: Tokunaga
authors: Hiroyuki
authors: H
authors: Ono
authors: Masanori
authors: M
authors: Terashima
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome