The role of tumor size in surgical decision making after endoscopic resection for early gastric cancer.
Endoscopic resection (ER) is curative treatment option for early gastric cancer (EGC). Additional surgery is required when the tumor pathology is beyond ER indication. It is unclear whether tumor size can be correlated with indications for surgery after ER. Therefore, we aimed to access the role of tumor size for surgical decision making after ER.



We reviewed clinicopathological data from 3246 patients underwent gastrectomy for EGC. The patients were classified into three groups as follows: the ulcer-negative intramucosal cancer with undifferentiated histology, ulcerative intramucosal cancer with differentiated histology, and minute submucosal (SM1) cancer with differentiated histology. The probability of additional surgery after ER was defined as at least one positive result for lymph node metastasis, lymphovascular invasion or perineural invasion. The probability was compared between individual tumor size and ER size criteria in each group using area under receiver operating characteristic curves.



The probabilities of ulcer-negative intramucosal cancer with undifferentiated histology, SM1 cancer with differentiated histology and ulcerative intramucosal cancer with differentiated histology were 4.2, 22.1 and 2.5 %. In the ulcerative intramucosal cancer with differentiated histology group, these probabilities increased when the difference in tumor size was >1 mm compared with ER size criteria. The probability was not increased when there was a >10-mm tumor size difference compared with ER size criteria in the other two groups.



Tumor size was correlated with ER criteria in patients with ulcerative intramucosal cancer with differentiated histology after ER but was not strictly correlated with ER criteria in the other two patient groups. However, further study may be necessary to validate our results in the future.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Hae Won
HW
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yoo Jin
YJ
Lee
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. otilia94@yuhs.ac.|Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. otilia94@yuhs.ac.|Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea. otilia94@yuhs.ac.
Jie-Hyun
JH
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Jae Jun
JJ
Park
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Young Hoon
YH
Youn
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.|Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Hyojin
H
Park
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Jong Won
JW
Kim
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Seung Ho
SH
Choi
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Sung Hoon
SH
Noh
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D000069916:Endoscopic Mucosal Resection / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D047368:Tumor Burden
Additive treatment; Early gastric cancer; Endoscopic resection; Tumor size