Optimal Lymphadenectomy for Patients with Noncurative Resection after Endoscopic Submucosal Dissection for Early Gastric Cancer Using the eCura System

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  • eCura systemを用いた早期胃癌ESD非治癒切除病変に対する至適リンパ節郭清の検討

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<p>Purpose: This study was designed to evaluate optimal lymphadenectomy for patients with noncurative resection after endoscopic submucosal dissection (ESD) for early gastric cancer using the eCura system. Methods: We examined 80 patients who underwent additional surgical resection for noncurative resection after ESD for early gastric cancer between January 2013 and February 2020. For comparison, we also examined 54 patients who underwent initial surgical resection for small advanced gastric cancer (<30 mm) with no lymph node metastases clinically, who were not indicated for ESD, during the same period. All patients were classified into three groups by risk level according to the eCura system, and the rate of lymph node metastasis was calculated in each group. Results: In the 80 patients treated with ESD, the median age was 71 years (40–90 years), 73 were men, the median follow-up period was 31 months (0–82 months), the rate of undifferentiated carcinoma was 23.8% (19 patients), and the rate of lymph node metastasis in each group was low risk, 4.0% (1/25 patients); intermediate risk, 11.1% (4/36); and high risk, 26.3% (5/19). One patient in the high risk group underwent D1 lymphadenectomy alone because of a comorbidity and died of recurrence of lymph node metastasis 3 months after additional surgical resection. The recurrence sites were lymph node stations 8a and 12a, which would have been dissected if D2 lymphadenectomy had been performed. In the 54 patients who did not undergo ESD, the rate of lymph node metastasis of 20.4% (11 patients) was higher than that in the high risk group. Conclusion: Patients with noncurative resection after ESD for early gastric cancer who are in the high risk group in the eCura system are more likely to have lymph node metastasis, and adequate lymphadenectomy including D2 lymphadenectomy should be considered for these patients.</p>

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