title: Is endoscopic submucosal dissection safe for papillary adenocarcinoma of the stomach?
abstract: OBJECTIVE
  To identify the clinicopathological predictors of lymph node (LN) metastasis and evaluate the outcomes of endoscopic submucosal dissection (ESD) in papillary adenocarcinoma-type early gastric cancers (EGCs).
  
  
  METHODS
  From January 2005 to May 2013, 49 patients who underwent surgical operation and 24 patients who underwent ESD for papillary adenocarcinoma-type EGC were enrolled to identify clinicopathological characteristics and predictive factors of LN metastasis and to evaluate the outcomes of ESD for papillary adenocarcinoma-type EGC.
  
  
  RESULTS
  Most papillary adenocarcinoma-type EGCs were located in the lower third of the stomach and had an elevated macroscopic shape. The overall prevalence of LN metastasis was 18.3% (9/49). The presence of lymphovascular invasion was found to be a predictor of LN metastasis (P = 0.016). According to current indication criteria of ESD, 6 and 11 of the 49 patients had absolute and expanded indications for ESD, respectively. Two patients (11.8%) with expanded indication for ESD had LN metastasis. Of the 24 patients who underwent ESD, 13 (54%) achieved out-of-ESD indication, with 9 of those 13 patients undergoing surgical operation due to non-curative resection.
  
  
  CONCLUSIONS
  The use of ESD should be carefully considered for papillary adenocarcinoma-type EGC with suspected ESD indication after pre-treatment work-up because of the higher frequency of LN metastasis and additional surgeries.
authors: Hyun Jeong Lee, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea.
authors: Hyun Jeong
authors: HJ
authors: Lee
authors: Hyun Jeong Lee, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea.
authors: Gwang Ha
authors: GH
authors: Kim
authors: Hyun Jeong Lee, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea.
authors: Do Youn
authors: DY
authors: Park
authors: Hyun Jeong Lee, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea.
authors: Bong Eun
authors: BE
authors: Lee
authors: Hyun Jeong Lee, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea.
authors: Hye Kyung
authors: HK
authors: Jeon
authors: Hyun Jeong Lee, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea.
authors: Joon Hyung
authors: JH
authors: Jhi
authors: Hyun Jeong Lee, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea.
authors: Geun Am
authors: GA
authors: Song
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D016145:Endoscopy, Digestive System; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005773:Gastroscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Gastric cancer; Lymph node; Metastasis; Papillary adenocarcinoma