Predictive factors for lymph node metastasis and defining a subgroup treatable for laparoscopic lymph node dissection after endoscopic submucosal dissection in poorly differentiated early gastric cancer
| Autor: | Fan-Ting Kong, Zhi-Bin Huo, Hua Li, Wen-Quan Liang, Deng-Xiang Liu, Yunhe Gao, Qing-Qiang He |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Laparoscopic lymph node dissection Poorly differentiated cancer Lymph node metastasis Dissection (medical) 03 medical and health sciences 0302 clinical medicine Retrospective Study medicine Lymph node Early gastric cancer business.industry Poorly differentiated Gastroenterology Endoscopic submucosal dissection medicine.disease Early Gastric Cancer medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Radiology business |
| Zdroj: | World Journal of Gastrointestinal Oncology |
| ISSN: | 1948-5204 |
| DOI: | 10.4251/wjgo.v10.i10.360 |
| Popis: | AIM To investigate the predictive factors of lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC); to guide the individual application of a combination of endoscopic submucosal dissection (ESD) and laparoscopic lymph node dissection (LLND) in a suitable subgroup of patients with poorly differentiated EGC. METHODS We retrospectively analyzed 138 patients with poorly differentiated EGC who underwent gastrectomy with lymphadenectomy between January 1990 and December 2015. The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95% confidence interval (95%CI) were calculated. We further examined the relationship between the positive number of the significant predictive factors and the LNM rate. RESULTS The tumor diameter (OR = 13.438, 95%CI: 1.773-25.673, P = 0.029), lymphatic vessel involvement (LVI) (OR = 38.521, 95%CI: 1.975-68.212, P = 0.015) and depth of invasion (OR = 14.981, 95%CI: 1.617-52.844, P = 0.024) were found to be independent risk factors for LNM by multivariate analysis. For the 138 patients diagnosed with poorly differentiated EGC, 21 (15.2%) had LNM. For patients with one, two and three of the risk factors, the LNM rates were 7.7%, 47.6% and 64.3%, respectively. LNM was not found in 77 patients that did not have one or more of the three risk factors. CONCLUSION ESD might be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2 cm in size and when LVI is absent upon postoperative histological examination. ESD with LLND may lead to the elimination of unnecessary gastrectomy in poorly differentiated EGC. |
| Databáze: | OpenAIRE |
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