title: [Impact of additional gastrectomy after endoscopic submucosal dissection on the prognosis of early gastric cancer].
abstract: OBJECTIVE
  To investigate the impact of additional gastrectomy after endoscopic submucosal dissection(ESD) on the prognosis of early gastric cancer.
  
  
  METHODS
  Clinical data of 107 early gastric cancer patients undergoing additional gastrectomy after ESD (research group, n=44) or radical surgery (control group, n=63) from January 2008 to December 2014 in Zhongshan Hospital were retrospectively analyzed. The reasons for additional gastrectomy after ESD included positive resection margin (n=10), lymphovascular invasion (n=5), well-differentiated mucosal tumor with a diameter >3 cm (n=10), poor-differentiated mucosal tumor with a diameter >2 cm (n=4), submucosal tumor(sm1) with a diameter >3 cm (n=10), and submucosal tumor(sm2) (n=9). Operation time, length of stay, lymph node metastasis, tumor recurrence and disease-free survival rate were compared between two groups.
  
  
  RESULTS
  Baseline data of two groups were not significantly different (all P>0.05). After evaluation, absolute and relative indications were identified in 19 cases (43.2%) and 25 cases (56.8%) of research group, and in 28 cases (44.4%) and 35 cases(55.6%) of control group without significant difference (P=0.897). Lymph node metastasis occurred in 6 patients (4.5%) after surgery in research group and 6.3% in control group (P=0.690). Operation time was (218.5±74.3) minutes in research group and (219.8±81.8) minutes in control group (P=0.932). Length of stay was (10.0±12.3) days in research group and (10.8±9.9) days in control group (P=0.687). Follow-up time was (35.5±15.0) months in research group and (29.5±18.1) months in control group (P=0.072). Tumor recurrence rate was 4.5% in research group and 9.5% in control group (χ(2)=0.928, P=0.229). Mortality was 4.5% in research group and 7.9% in control group (χ(2)=0.487, P=0.485). Besides, no significant differences of operation mode (P=0.164), lymphatic clearance mode (P=0.330), number of harvested lymph node (P=0.467), morbidity of postoperative infection or fever (P=0.923) were found. Three-year tumor-free survival rate was 95.5% and 89.2% in research and control group respectively without significant differences (P=0.571).
  
  
  CONCLUSIONS
  Additional gastrectomy after endoscopic submucosal dissection has no negative influence on the prognosis of patients with early gastric cancer, whose efficacy is similar to simple radical gastrectomy.
authors.forename: Junyu
authors.initials: J
authors.lastname: Zhu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China. zhou.pinghong@zs-hospital.sh.cn.
authors.forename: Pinghong
authors.initials: P
authors.lastname: Zhou
authors.forename: Tianyin
authors.initials: T
authors.lastname: Chen
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Xu
authors.forename: Jingzheng
authors.initials: J
authors.lastname: Liu
authors.forename: Liqing
authors.initials: L
authors.lastname: Yao
authors.forename: Meidong
authors.initials: M
authors.lastname: Xu
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa; D006801:Humans; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate