title: Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer (EGC) without lymph node metastasis. However, some patients undergo noncurative ESD. The aim of the present study was to assess the long-term clinical outcomes of noncurative ESD with or without additional surgery.
  
  
  METHODS
  We investigated the chart data from all patients who had undergone ESD for EGC at Saga Medical School Hospital and Saga Prefectural Medical Centre Koseikan between 2001 and 2012. A total of 957 cases (1047 lesions) of EGC underwent ESD, and 99 had noncurative ESD. In total, 20 cases were excluded because their follow-up period was < 3 years. We divided the patients into observation and additional surgery groups, and we compared the survival rate and related factors between the groups.
  
  
  RESULTS
  After noncurative ESD, 28 /79 patients (35.4 %) underwent additional surgery and 51/79 (64.6 %) were followed up without surgery. The average age of patients in the observation group was higher than that of the additional surgery group (75.9 vs. 71.6 years; P = 0.03). The incidence of hypertension was significantly higher in the observation group compared with the additional surgery group (51.0 vs. 25.9 %; P = 0.03). The overall survival rate of the additional surgery group was longer than that of the observation group. However, only one patient died from gastric cancer in the observation group. The disease-specific survival rate did not differ significantly between the groups.
  
  
  CONCLUSIONS
  It might be acceptable to follow up without additional surgery for some patients with comorbidity and who were elderly after noncurative ESD for EGC.
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Yamanouchi
authors.affiliation: Department of Gastroenterology, Saga Prefectural Medical Centre Koseikan, Saga 840-8571, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ogata
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Sakata
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Nanae
authors.initials: N
authors.lastname: Tsuruoka
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Shimoda
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakayama
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akutagawa
authors.affiliation: Department of Gastroenterology, Saga Prefectural Medical Centre Koseikan, Saga 840-8571, Japan.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Shirai
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Takeshita
authors.affiliation: Department of Gastroenterology, Saga Prefectural Medical Centre Koseikan, Saga 840-8571, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
authors.affiliation: Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Iwakiri