title: Risk stratification and management of non-curative resection after endoscopic submucosal dissection for early gastric cancer.
abstract: BACKGROUND
  Non-curative resection after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) can contribute to local recurrence or lymphatic and distant metastasis of the tumor. We stratified the risk of local recurrence according to the histological characteristics in non-curative resection after ESD for EGC.
  
  
  METHODS
  Among 892 EGCs treated with ESD, 152 (17.0%) were classified as non-curative resection based on the histology after ESD. The clinical outcomes and risk factors associated with local recurrence were analyzed retrospectively in non-curative resections.
  
  
  RESULTS
  Of 152 non-curative resections, 46 (30.3%) were stratified as Group 1 (incomplete resection and met the ESD criteria), 31 (20.4%) as Group 2 (complete resection and exceeded the ESD criteria), 41 (27.0%) as Group 3 (incomplete resection and exceeded the ESD criteria), and 34 (22.4%) as Group 4 (lymphovascular invasion regardless of complete resection). Group 3 [odds ratio (OR) 3.991; p = 0.015] and Group 4 (OR 4.487; p = 0.014) had higher rates of local recurrence after non-curative resection. In those high-risk groups, endoscopic surveillance without additional treatment detected significantly more local recurrence than in those receiving additional treatment (p = 0.029).
  
  
  CONCLUSIONS
  Risk stratification for non-curative resection is important for EGC prognosis after ESD. Moreover, additional treatment for non-curative resection influences long-term outcomes, especially in high-risk groups.
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Han
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea. sjhong@schmc.ac.kr.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Yun Nah
authors.initials: YN
authors.lastname: Lee
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Bong Min
authors.initials: BM
authors.lastname: Ko
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Cho
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D004210:Dissection; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Early gastric cancer; Endoscopic submucosal dissection; Non-curative resection
references.citation: Jpn J Clin Oncol. 2004 Jan;34(1):58
references.pmid: 15061149
references.citation: Gastrointest Endosc. 2006 Dec;64(6):877-83
references.pmid: 17140890
references.citation: Br J Surg. 2008 Dec;95(12):1495-500
references.pmid: 18942058
references.citation: Endoscopy. 2012 Feb;44(2):122-7
references.pmid: 22271022
references.citation: Dig Endosc. 2014 Mar;26(2):183-91
references.pmid: 23560494
references.citation: Surg Endosc. 2011 Mar;25(3):841-8
references.pmid: 20734082
references.citation: Gut Liver. 2008 Dec;2(3):174-9
references.pmid: 20485643
references.citation: Clin Gastroenterol Hepatol. 2005 Jul;3(7 Suppl 1):S71-3
references.pmid: 16013003
references.citation: Endoscopy. 2013 Sep;45(9):703-7
references.pmid: 23990481
references.citation: Surg Endosc. 2014 Jul;28(7):2097-105
references.pmid: 24488356
references.citation: Gastric Cancer. 2000 Dec;3(4):219-225
references.pmid: 11984739
references.citation: Endoscopy. 2012 Dec;44(12):1114-20
references.pmid: 23188661
references.citation: J Gastric Cancer. 2011 Jun;11(2):109-15
references.pmid: 22076211
references.citation: Gastric Cancer. 2014 Jan;17(1):130-6
references.pmid: 23576197
references.citation: Surg Endosc. 2013 Nov;27(11):4250-8
references.pmid: 23765426
references.citation: Gastrointest Endosc. 2011 Dec;74(6):1268-75
references.pmid: 22015001
references.citation: Int Surg. 1995 Jul-Sep;80(3):200-3
references.pmid: 8775601
references.citation: Surg Endosc. 2013 Dec;27(12 ):4656-62
references.pmid: 23943115
references.citation: Dig Endosc. 2011 Jul;23(3):233-9
references.pmid: 21699567
references.citation: Gastrointest Endosc. 2012 Oct;76(4):763-70
references.pmid: 22884100
references.citation: Ann Surg Oncol. 2007 Dec;14(12):3428-34
references.pmid: 17899290
references.citation: Gastrointest Endosc. 2009 Jun;69(7):1228-35
references.pmid: 19249769
references.citation: Clin Endosc. 2013 May;46(3):235-8
references.pmid: 23767032
references.citation: Eur J Gastroenterol Hepatol. 2010 Mar;22(3):311-7
references.pmid: 19494784
references.citation: Dig Liver Dis. 2013 Feb;45(2):170-5
references.pmid: 23102499
references.citation: J Gastroenterol Hepatol. 2010 Mar;25(3):506-11
references.pmid: 20074167