Daisuke Ichikawa, MD1, Hidenori Akaike, MD1, Yoshihiko Kawaguchi, MD1, Kensuke Shiraishi, MD1, Yuki Nakata, MD1, Naohiro Hosomura, MD1, Mitsuhiro Watanabe, MD1, Hideya Amemiya, MD1, Hiromitsu Kawaida, MD1, Makoto Sudoh, MD1, Hiroshi Kohno, MD1, Katsutoshi Shoda, MD2, Eigo Otsuji, MD2. 1University of Yamanashi, 2Kyoto Prefectural University of Medicine
INTRODUCTION: Extended indications of endoscopic resection for early gastric cancer (EGC) have been widely accepted. According to current Japanese guidelines, additional gastrectomy with lymph node dissection (LND) is recommended for patients proven to have potential risks of lymph node metastasis (LNM) on histopathological findings. On the other hand, the frequency of LNM in these patients is exteremely low. The aim of this study was to elucidate the accurate risk of LNM based on the number of risk factors (RF) for possible LNM, and to compare the stratified risk of LNM with predicted risk from additional radical resection.
METHODS and PROCEDURES: We enrolled 589 EGC patients who did not meet absolute or extended indications of endoscopic resection, and investigated the risk stratification of LNM according to the total number of LNM RFs described below; 1)SM2, 2)lymphatic vessels invasion, 3)Undifferentiated adenocarinoma and >20mm in diameter, and 4)>30mm in diameter and ulcer formation. We compared the stratification risk to the surgical risk that was calculated based on the Japanese National Clinical Database (NCD) risk calculator in 52 patients with additional gastrectomy after ESD.
RESULTS: The total number of LNM RFs and frequency of LNM were significantly correlated (0/1RF;0.85%, 2RFs;10.88%, 3RFs,31.40%, 4RFs53.57% ; p<0.05, Fischer exact test). The estimated frequency of LNM was found to be lower than the predicted value of in-hospital mortality rate based on NCD in 24.3% of 0/1RF-patients who underwent additional gastrectomy with LND after ESD.
CONCLUSIONS: The present study suggested that some patients must be over-indicated for additional gastrectomy with LND, and no additional surgical treatment or less invasive surgery, such as local LND (Sentinel node navigation surgery or lymphatic basin resection), might be indicated for some patients with low number (0/1 RF) of LNM risk factors after ESD.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86947
Program Number: P421
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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