title: Is It Reasonable to Treat Early Gastric Cancer with Mucosal Infiltration and Well Differentiation by Endoscopic Submucosal Resection?
abstract: BACKGROUND
  While limited endoscopic submucosal dissection (ESD) is increasingly applied in the treatment of early gastric cancer, preoperative prediction of lymph node metastasis is very critical for determining treatment strategies preoperatively. Thus, the aim of this study was to accurately assess the prevalence and pattern of lymph node metastasis in early gastric cancer patients and to identify the best candidates for ESD.
  
  
  METHODS
  From September 2008 to December 2013, a total of 539 patients with early gastric cancer were retrospectively analyzed in the present study. Of them, 503 patients underwent radical gastrectomy and 36 patients underwent ESD. The clinicopathological features were collected and correlations with lymph node metastasis were analyzed. The survival rates of patients were also analyzed.
  
  
  RESULTS
  Lymph node metastasis was observed in 80 of 503 patients (15.9 %). Among these, the rate for mucosal cancer was 8.3 %, and 20.1 % for submucosal cancer. By univariate analysis, risk factors for lymph node metastasis were growth pattern, tumor size, pathological type, depth of invasion, lymphatic-vascular invasion, and neural invasion. By multivariate analysis, risk factors for lymph node metastasis were tumor size, pathological type, depth of invasion, and lymphatic-vascular invasion. The incidence of lymph node metastasis was 0 % in the well-differentiated mucosal cancers, irrespective of tumor size. For the well-differentiated mucosal cancers, the overall survival rates were comparable between patients underwent gastrectomy with lymph node dissection and patients underwent ESD (100 vs 100 %).
  
  
  CONCLUSIONS
  The most important factors for predicting lymph node metastasis in early gastric cancer are tumor size, pathological type, depth of invasion, and lymphatic-vascular invasion. Well-differentiated mucosal gastric cancers could be candidates for ESD.
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Feng
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China.
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China.
authors.forename: Guanghui
authors.initials: G
authors.lastname: Xu
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Cai
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Hong
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China.
authors.forename: Man
authors.initials: M
authors.lastname: Guo
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Lian
authors.affiliation: Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, 710032, Xi'an, Shaanxi, China. zhanghw41@126.com.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D004210:Dissection; D004724:Endoscopy; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Early gastric cancer; Endoscopic submucosal dissection; Lymph node metastasis; Radical gastrectomy