Determination of additional surgery after non‐curative endoscopic submucosal dissection in patients with early gastric cancer: A practically modified application of the ecura system

Sejin Lee, Jeong Ho Song, Sung Hyun Park, Minah Cho, Yoo Min Kim, Hyoung Il Kim, Woo Jin Hyung

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Additional surgery after non‐curative endoscopic submucosal dissection (ESD) may be excessive as few patients have lymph node metastasis (LNM). It is necessary to develop a risk stratification system for LNM after non‐curative ESD, such as the eCura system, which was introduced in the Japanese gastric cancer treatment guidelines. However, the eCura system requires venous and lymphatic invasion to be separately assessed, which is difficult to distinguish without special immunostaining. In this study, we practically modified the eCura system by classifying lymphatic and venous invasion as lymphovascular invasion (LVI). Method: We retrospectively reviewed 543 gastric cancer patients who underwent radical gastrectomy after non‐curative ESD between 2006 and 2019. LNM was evaluated according to LVI as well as size >30 mm, submucosal invasion ≥500μm, and vertical margin involvement, which were used in the eCura system. Results: LNM was present in 8.1% of patients; 3.6%, 2.3%, 7.4%, 18.3%, and 61.5% of patients with no, one, two, three, and four risk factors had LNM, respectively. The LNM rate in the patients with no risk factors (3.6%) was not significantly different from that in patients with one risk factor (2.3%, p = 0.523). Among patients with two risk factors, the LNM rate without LVI was significantly lower than with LVI (2.4% vs. 10.7%, p = 0.027). Among patients with three risk factors, the LNM rate without LVI was lower than with LVI (0% vs. 20.8%, p = 0.195), although not statistically significantly. Based on LNM rates according to risk factors, patients with LVI and other factors were assigned to the high‐risk group (LNM, 17.4%) while other patients as a low‐risk group (LNM, 2.4%). Conclusions: Modifying the eCura system by classifying lymphatic and venous invasion as LVI successfully stratified LNM risk after non‐curative ESD. Moreover, the high‐risk group can be simply identified based on LVI and the presence of other risk factors.

Original languageEnglish
Article number5768
JournalCancers
Volume13
Issue number22
DOIs
Publication statusPublished - 2021 Nov 1

Bibliographical note

Funding Information:
This work was supported by the Seoul R&BD program (CY200023). The funding source had no role in the design or conduct of the study; data collection, analysis, or interpretation; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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