title: Clinicopathological Outcomes of Patients with Early Gastric Cancer after Non-Curative Endoscopic Submucosal Dissection.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) was developed to resect early gastric cancer (EGC), which could not be resected by conventional endoscopic mucosal resection, and the indications for ESD are expanding to include more types of EGCs. Favorable long-term outcomes of ESD for EGCs that meet the expanded curability criteria have been reported. However, the outcomes of non-curative ESD are not known in detail.
  
  
  CONCLUSIONS
  We analyzed the outcomes of 165 EGCs in 165 patients after non-curative ESD, as well as the clinical course. Of these patients, 109 underwent additional surgical resection (group S) and 56 patients were followed up without additional surgery (group F). The complete resection rate was 90.7% (39/43) for intramucosal cancer (M), 97.3% (36/37) for minimally submucosal invasive cancer (SM1), and 74.1% (63/85) for deep submucosal invasive cancer (SM2). The lymph node metastasis rate was 0% for M, 5.4% for SM1, and 10.6% for SM2 cancers. Regarding long-term survival, although the number of patients who died of another disease was significantly higher in group F than in group S, there was no significant difference in overall survival between the groups.
  
  
  CONCLUSIONS
  The resectability of ESD for ECGs with an invasion depth of M to SM1 after non-curative ESD was excellent, and lesions without lymphovascular invasion did not metastasize or recur, resulting in a favorable prognosis. Our data may help in deciding whether additional surgery should be performed for borderline lesions after non-curative ESD. Furthermore, we suggest the possibility of further expanding the indications for ESD.
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Hoteya
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iizuka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kikuchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Mitani
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Furuhata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamada
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden