Extragastric metastasis of early gastric cancer after endoscopic submucosal dissection with lymphovascular invasion and negative resected margins
Background: Lymphovascular invasion is a criterion for noncurative resection in patients who have undergone endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to determine the rate of extragastric metastasis (EGM) and identify predictors of EGM in patients with negative resected margins (R0 resection) and lymphovascular invasion in their post-ESD pathology.Methods: Among 2,983 consecutive patients, 110 were treated with ESD with follow-up pathology of R0 resection
... d lymphovascular invasion. Patients received additional gastrectomy (n=63) or further follow-up without gastrectomy (n=47).Results: The 110 patients were assigned to one of three groups according to ESD indications based on post-ESD pathology. Group 1 satisfied the absolute indication of ESD (n=18), group 2 satisfied the expanded indication of ESD (n=34), and group 3 was beyond indication (n=58). The number of occurrences of EGM in each group was 1 (5.6%), 3 (8.8%), and 3 (5.2%), respectively. The logistic regression analysis, which adjusted for age, sex, tumor size, and indication of ESD, showed that larger tumor size was associated with EGM (odds ratio 1.76, 95% confidence interval 1.00–3.10, p=0.048). By contrast, ESD indication criteria did not affect EGM (p=0.349).Conclusions: Tumor size was the only predictive indicator for EGM in patients with R0 resection and lymphovascular invasion in their post-ESD pathology. Even patients with pathology corresponding to the absolute indication criteria of ESD had lymphovascular invasion, which means they require an additional gastrectomy due to the risk of EGM.