Purpose Expanded indications for endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) remain controversial due to the potential risk of undertreatment after adequate lymph node dissection (LND). Regional LND (RLND) is a novel technique used for limited lymphadenectomy to avoid gastrectomy. This study established the safety and effectiveness of RNLD as an additional treatment option after ESD for expanded indications. Materials and Methods A total of 69 patients who met the expanded indications for ESD were prospectively enrolled from 2014 to 2017. The tumors were localized using intraoperative esophagogastroduodenoscopy (EGD) before RLND. All patients underwent RLND first, followed by conventional radical gastrectomy with LND. The locations of the preoperative and intraoperative EGD were compared. Pathologic findings of the primary lesion and the RLND status were analyzed. Results The concordance rates of tumor location between the preoperative and intraoperative EGD were 79.7%, 76.8%, and 63.8% according to the longitudinal, circumferential, and regional locations, respectively. Of the 4 patients (5.7%) with metastatic LNs, 3 were pathologically classified as beyond the expanded indication for ESD and 1 had a single LN metastasis in the regional lymph node. Conclusions RLND is a safe additional option for the treatment of EGC in patients meeting expanded indications after ESD.

中文翻译：

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局部淋巴结清扫作为胃癌扩大适应症内镜切除术的附加治疗选择：一项前瞻性队列研究

目的 由于充分淋巴结清扫 (LND) 后治疗不足的潜在风险，早期胃癌 (EGC) 内镜黏膜下剥离术 (ESD) 的扩大适应症仍存在争议。区域 LND (RLND) 是一种用于有限淋巴结切除术以避免胃切除术的新技术。这项研究确定了 RNLD 作为 ESD 后扩大适应症的额外治疗选择的安全性和有效性。材料与方法 2014 年至 2017 年前瞻性纳入 69 例符合 ESD 扩大适应症的患者。在 RLND 之前使用术中食管胃十二指肠镜 (EGD) 对肿瘤进行定位。所有患者均先行 RLND，然后行常规根治性胃切除术和 LND。比较术前和术中EGD的位置。分析原发灶的病理结果和 RLND 状态。结果术前和术中EGD的肿瘤定位符合率分别为79.7%、76.8%和63.8%。在 4 名转移性 LN 患者中（5.7%），3 名在病理学上被归类为超出 ESD 的扩大适应症，1 名在区域淋巴结中有单个 LN 转移。结论 RLND 是 ESD 后满足扩大适应症患者 EGC 治疗的一种安全的附加选择。在 4 名转移性 LN 患者中（5.7%），3 名在病理学上被归类为超出 ESD 的扩大适应症，1 名在区域淋巴结中有单个 LN 转移。结论 RLND 是 ESD 后满足扩大适应症患者 EGC 治疗的一种安全的附加选择。在 4 名转移性 LN 患者中（5.7%），3 名在病理学上被归类为超出 ESD 的扩大适应症，1 名在区域淋巴结中有单个 LN 转移。结论 RLND 是 ESD 后满足扩大适应症患者 EGC 治疗的一种安全的附加选择。