Background and Aims

Early gastric cancer (EGC) is known to present a low rate of lymph node metastases (LNMs). Gastrectomy with D2 lymphadenectomy is usually curative for EGC. Endoscopic submucosal dissection (ESD) is a well-accepted treatment modality for lesions that meet the classic criteria: those mucosal differentiated adenocarcinoma measuring 20 mm or less, without ulceration. Expanded criteria for ESD have been proposed based on a null LNM rate from large gastrectomy series from Japan. Patients with LNM have been reported in Western centers, heightening the need for validation of expanded criteria. Our aim was to assess the risk of LNM in gastrectomy specimens of patients with EGC who met the expanded criteria for ESD.

Methods

We conducted an evaluation of gastrectomy specimens including LNM staging of patients submitted to gastrectomy for EGC in a 39-year retrospective cohort.

Results

A total of 389 surgical specimens were included. From them, 135 fulfilled criteria for endoscopic resection. None of the 31 patients with classic criteria had LNM. From the 104 patients with expanded criteria, 3 had LNM (n = 104 [2.9%], 95% confidence interval, .7%-8.6%), all of them with undifferentiated tumors without ulceration, measuring less than 20 mm.

Conclusions

There is a small risk of LNM in EGC when expanded criteria for ESD are met. Refinement of the expanded criteria for the risk of LNM may be desirable in a Brazilian cohort. Meanwhile, the decision to complement the endoscopic treatment with gastrectomy will have to take into consideration the individual risk of perioperative morbidity and mortality.

中文翻译：

---

符合扩大内镜切除标准的早期胃腺癌淋巴结转移的风险评估

背景和目标

已知早期胃癌（EGC）的淋巴结转移（LNMs）发生率低。D2淋巴结清扫术通常可治愈EGC。内镜下粘膜下剥离术（ESD）是符合经典标准的病变的一种公认的治疗方式：那些粘膜分化的腺癌尺寸为20 mm或更小，没有溃疡。ESD的扩展标准是根据来自日本大型胃切除术系列的无效LNM率提出的。已经在西方中心报道了LNM患者，这增加了对扩展标准进行验证的需求。我们的目的是评估符合扩展的ESD标准的EGC患者的胃切除标本中LNM的风险。

方法

我们对一项胃切除术标本进行了评估，包括对39年回顾性队列中接受胃切除术进行EGC的患者的LNM分期。

结果

总共包括389个手术标本。从他们中，有135个符合内镜切除标准。31名符合经典标准的患者均无LNM。在104例标准扩大的患者中，有3例患有LNM（n = 104 [2.9％]，置信区间为95％，0.7％-8.6％），所有这些患者的肿瘤均未分化，没有溃疡，直径小于20毫米。

结论

如果满足扩展的ESD标准，则EGC中存在LNM的风险很小。在巴西队列中，可能需要完善扩展的LNM风险标准。同时，决定用胃切除术补充内窥镜治疗必须考虑到围手术期发病和死亡的个体风险。