Additive lymph node dissection may be necessary in minute submucosal cancer of the stomach after endoscopic resection

Jie-Hyun Kim, Yongchan Lee, Hyunki Kim, SunOch Yoon, Hoguen Kim, Young Hoon Youn, HyoJin Park, Sang In Lee, Seung Ho Choi, Sung Hoon Noh

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Abstract

Purpose. In early gastric cancer (EGC), minute submucosal (SM1) invasion of the stomach has been regarded as an expanded indication for endoscopic resection (ER). The exact prediction of SM1 invasion before ER may be difficult. Thus, SM1 invasion may be important to decide additive treatment after ER. This study was designed to investigate the incidence of lymph node metastasis (LNM) in SM1-EGC based on surgical specimens and to evaluate the factors that indicate additional treatment after ER. Methods. From May 2005 to December 2008, 1,676 patients with EGC underwent surgery at Severance and Gangnam Severance Hospital, Seoul, Korea. Among them, 126 patients were diagnosed with differentiated SM1-EGC. The clinicopathologic characteristics were analyzed with respect to LNM and lymphovascular invasion (LVI), which is a known independent risk factor for LNM. Intratumoral marker immunohistochemistry was examined as a predictor of LVI. Results. The mean SM1 invasion depth was 621.3 ±745.6 lm. The LNM rates did not differ significantly between differentiated SM1-EGC (6.3%) and SM1-EGC (4.1%) meeting the expanded indication for ER. Female gender, moderate differentiation, LVI, and LVI grade were positively correlated with LNM. Female gender and elevated lesion morphology were associated with LVI. The expression levels of VEGF-C and OPHN1 were higher in LVI-positive tissues. Conclusions. The LNM rate in differentiated SM1-EGC meeting the expanded ER criteria was 4.1% in the present study, indicating that additional lymph node dissection may be necessary after ER in some cases of SM1-EGC.

Original languageEnglish
Pages (from-to)779-785
Number of pages7
JournalAnnals of Surgical Oncology
Volume19
Issue number3
DOIs
Publication statusPublished - 2012 Mar 1

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Lymph Node Excision
Stomach Neoplasms
Lymph Nodes
Neoplasm Metastasis
Vascular Endothelial Growth Factor C
Korea
Stomach
Immunohistochemistry
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Kim, Jie-Hyun ; Lee, Yongchan ; Kim, Hyunki ; Yoon, SunOch ; Kim, Hoguen ; Youn, Young Hoon ; Park, HyoJin ; Lee, Sang In ; Choi, Seung Ho ; Noh, Sung Hoon. / Additive lymph node dissection may be necessary in minute submucosal cancer of the stomach after endoscopic resection. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 3. pp. 779-785.
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abstract = "Purpose. In early gastric cancer (EGC), minute submucosal (SM1) invasion of the stomach has been regarded as an expanded indication for endoscopic resection (ER). The exact prediction of SM1 invasion before ER may be difficult. Thus, SM1 invasion may be important to decide additive treatment after ER. This study was designed to investigate the incidence of lymph node metastasis (LNM) in SM1-EGC based on surgical specimens and to evaluate the factors that indicate additional treatment after ER. Methods. From May 2005 to December 2008, 1,676 patients with EGC underwent surgery at Severance and Gangnam Severance Hospital, Seoul, Korea. Among them, 126 patients were diagnosed with differentiated SM1-EGC. The clinicopathologic characteristics were analyzed with respect to LNM and lymphovascular invasion (LVI), which is a known independent risk factor for LNM. Intratumoral marker immunohistochemistry was examined as a predictor of LVI. Results. The mean SM1 invasion depth was 621.3 ±745.6 lm. The LNM rates did not differ significantly between differentiated SM1-EGC (6.3{\%}) and SM1-EGC (4.1{\%}) meeting the expanded indication for ER. Female gender, moderate differentiation, LVI, and LVI grade were positively correlated with LNM. Female gender and elevated lesion morphology were associated with LVI. The expression levels of VEGF-C and OPHN1 were higher in LVI-positive tissues. Conclusions. The LNM rate in differentiated SM1-EGC meeting the expanded ER criteria was 4.1{\%} in the present study, indicating that additional lymph node dissection may be necessary after ER in some cases of SM1-EGC.",
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Additive lymph node dissection may be necessary in minute submucosal cancer of the stomach after endoscopic resection. / Kim, Jie-Hyun; Lee, Yongchan; Kim, Hyunki; Yoon, SunOch; Kim, Hoguen; Youn, Young Hoon; Park, HyoJin; Lee, Sang In; Choi, Seung Ho; Noh, Sung Hoon.

In: Annals of Surgical Oncology, Vol. 19, No. 3, 01.03.2012, p. 779-785.

Research output: Contribution to journalArticle

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T1 - Additive lymph node dissection may be necessary in minute submucosal cancer of the stomach after endoscopic resection

AU - Kim, Jie-Hyun

AU - Lee, Yongchan

AU - Kim, Hyunki

AU - Yoon, SunOch

AU - Kim, Hoguen

AU - Youn, Young Hoon

AU - Park, HyoJin

AU - Lee, Sang In

AU - Choi, Seung Ho

AU - Noh, Sung Hoon

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N2 - Purpose. In early gastric cancer (EGC), minute submucosal (SM1) invasion of the stomach has been regarded as an expanded indication for endoscopic resection (ER). The exact prediction of SM1 invasion before ER may be difficult. Thus, SM1 invasion may be important to decide additive treatment after ER. This study was designed to investigate the incidence of lymph node metastasis (LNM) in SM1-EGC based on surgical specimens and to evaluate the factors that indicate additional treatment after ER. Methods. From May 2005 to December 2008, 1,676 patients with EGC underwent surgery at Severance and Gangnam Severance Hospital, Seoul, Korea. Among them, 126 patients were diagnosed with differentiated SM1-EGC. The clinicopathologic characteristics were analyzed with respect to LNM and lymphovascular invasion (LVI), which is a known independent risk factor for LNM. Intratumoral marker immunohistochemistry was examined as a predictor of LVI. Results. The mean SM1 invasion depth was 621.3 ±745.6 lm. The LNM rates did not differ significantly between differentiated SM1-EGC (6.3%) and SM1-EGC (4.1%) meeting the expanded indication for ER. Female gender, moderate differentiation, LVI, and LVI grade were positively correlated with LNM. Female gender and elevated lesion morphology were associated with LVI. The expression levels of VEGF-C and OPHN1 were higher in LVI-positive tissues. Conclusions. The LNM rate in differentiated SM1-EGC meeting the expanded ER criteria was 4.1% in the present study, indicating that additional lymph node dissection may be necessary after ER in some cases of SM1-EGC.

AB - Purpose. In early gastric cancer (EGC), minute submucosal (SM1) invasion of the stomach has been regarded as an expanded indication for endoscopic resection (ER). The exact prediction of SM1 invasion before ER may be difficult. Thus, SM1 invasion may be important to decide additive treatment after ER. This study was designed to investigate the incidence of lymph node metastasis (LNM) in SM1-EGC based on surgical specimens and to evaluate the factors that indicate additional treatment after ER. Methods. From May 2005 to December 2008, 1,676 patients with EGC underwent surgery at Severance and Gangnam Severance Hospital, Seoul, Korea. Among them, 126 patients were diagnosed with differentiated SM1-EGC. The clinicopathologic characteristics were analyzed with respect to LNM and lymphovascular invasion (LVI), which is a known independent risk factor for LNM. Intratumoral marker immunohistochemistry was examined as a predictor of LVI. Results. The mean SM1 invasion depth was 621.3 ±745.6 lm. The LNM rates did not differ significantly between differentiated SM1-EGC (6.3%) and SM1-EGC (4.1%) meeting the expanded indication for ER. Female gender, moderate differentiation, LVI, and LVI grade were positively correlated with LNM. Female gender and elevated lesion morphology were associated with LVI. The expression levels of VEGF-C and OPHN1 were higher in LVI-positive tissues. Conclusions. The LNM rate in differentiated SM1-EGC meeting the expanded ER criteria was 4.1% in the present study, indicating that additional lymph node dissection may be necessary after ER in some cases of SM1-EGC.

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