Extended Indication Criteria for Endoscopic Mucosal Resection of Early Gastric Cancer with Special Reference to Lymph Node Metastasis-Examination by Multivariate Analysis-

Abstract

The purpose of this study was to clarify extended indication criteria of endoscopic mucosal resection (EMR) for early gastric cancer (EGC) by analyzing the independent risk factors involved in lymph node metastasis (LNM). Subjects were 422 patients who underwent gastrectomy with lymph node dissection for EGC at the Kurume University Hospital from 1994 to 2001. The EGCs were mucosal cancers (M) in 252 cases and submucosal cancers (SM) in 170 cases. Twelve clinico-pathological factors were assessed for their possible association with LNM. On univariate analysis, EGC with LNM showed the following characteristics: size; 3.1 cm or more, ulceration; present, heterogeneity; present, differentiation; poor, lymphatic vascular invasion; present, and invasion depth; SM2 (cancer penetration of submucosal layer, 0.5 mm or more from the muscularis mucosa). On multivariate analysis, the following four factors were identified as independent risk factors; invasion depth: Odds Ratio (OR) 10.9, lymphatic vascular invasion: OR 10.6, size: OR 3.2, and ulceration: OR 3.2. The incidence of LNM was 0% (0/141) (95% confidence interval, 0-2.6%) when these risk factors met the following four conditions: invasion depth; M or SM1 (cancer penetration of submucosal layer, less than 0.5 mm), lymphatic vascular invasion; absent, size; 3.0 cm or less, and ulceration; absent. It is concluded that EMR is a suitable radical treatment for EGC, and that the indication criteria for EMR can be extended depending on the results of the histological evaluation of the en bloc/total resected specimen concerning the above four factors for LNM.

Clinicopathological study of lymph‐node metastasis in 1389 patients with early gastric cancer: Assessment of indications for endoscopic resection

“…Histopathological evaluation of the invasion front is thus an important factor in estimating the risk of lymph‐node metastasis, even for tiny carcinomas. Our results are generally consistent with the findings of previous studies examining the conditions required for extending the indications for endoscopic treatment to tumors with sm1 invasion 14,15 . Because en bloc resection may be recommended, techniques such as ESD should be thoroughly mastered 6,16 .…”

Laparoscopic-Endoscopic Rendezvous Resection of Upper Gastrointestinal Tumors

“…Recently, especially in Japan, these criteria were expanded partially for tumors measuring ! 3 cm, poorly differentiated tumors and for tumors invading the upper submucosal layer [37] .…”

Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer

“…Moreover, en bloc and histologically complete resection of large tumors can be achieved with the recent development of ESD [14][15][16][17]. Therefore, expanded criteria have been recently proposed for the use of endoscopic resection in EGC.…”