title: Risk factors and management of positive horizontal margin in early gastric cancer resected by en bloc endoscopic submucosal dissection.
abstract: BACKGROUND
  Although endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric cancer (EGC), there is no consensus regarding the management of positive horizontal margin (HM) despite en bloc ESD. The aim of the current study was to identify the risk factors and optimal management of positive HM in EGCs resected by en bloc ESD.
  
  
  METHODS
  A total of 890 consecutive patients with 1,053 intramucosal EGCs resected by en bloc ESD between April 2005 and June 2011. Clinicopathological data were retrieved retrospectively to assess the positive HM rate, local recurrence rate, risk factors for positive HM, and outcomes of treatment for local recurrent tumor. Positive HM was defined as a margin with direct tumor invasion (type A), the presence of cancerous cells on either end of 2-mm-thick cut sections (type B), or an unclear tumor margin resulting from crush or burn damage (type C).
  
  
  RESULTS
  The positive HM rate was 2.0% (21/1,053). The local recurrence rate was 0.3% (3/1,053). All local recurrent tumors were intramucosal carcinomas, and were resected curatively by re-ESD. Multivariate analysis with logistic regression showed tumor location in the upper third of the stomach and lesions not matching the absolute indication to be independent risk factors for positive HM.
  
  
  CONCLUSIONS
  The risk factors for HM positivity in cases of EGC resected by en bloc ESD are tumor location in the upper third of the stomach and dissatisfaction of the absolute indication for curative ESD.
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan, nnumata@hiroshima-u.ac.jp.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Numata
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kagemoto
authors.forename: Yoji
authors.initials: Y
authors.lastname: Sanomura
authors.forename: Shigeto
authors.initials: S
authors.lastname: Yoshida
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.forename: Fumio
authors.initials: F
authors.lastname: Shimamoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000368:Aged; D019468:Disease Management; D004210:Dissection; D055088:Early Detection of Cancer; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*
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