Tumour size is related to the curability of signet ring cell early gastric cancer with endoscopic submucosal dissection: A retrospective single centre study

Background: Endoscopic submucosal dissection is applied in selected cases of signet ring cell early gastric cancer. However, factors related to curability of signet ring cell early gastric cancer with this method have not been fully evaluated. Our aim was to evaluate factors related to incomplete resection in signet ring cell early gastric cancer with endoscopic submucosal dissection. Methods: A retrospective analysis was performed on a total of 126 consecutive patients with signet ring cell early gastric cancer who had undergone endoscopic submucosal dissection at the Severance Hospital in Korea, between March 2007 and March 2012. The clinical outcomes were reviewed and factors related to incomplete resection were analysed. Results: Multivariate analysis showed that large tumour size was the only significant factor related to incomplete resection (. P=. 0.006; hazard ratio, 1.040; 95% confidence interval, 1.101-1.084). In addition, large tumour size was the only significant factor related to endoscopic size underestimation (. P<. 0.001; hazard ratio, 1.391; 95% confidence interval, 1.221-1.586). The rate of endoscopic size underestimation was significantly higher in tumours with a size ≥20. mm (. P<. 0.001). Conclusions: To improve the curability of signet ring cell early gastric cancer with endoscopic submucosal dissection, larger tumours (especially tumour with a size ≥20. mm) should be resected with a larger margin.