Oncologic Safety of Endoscopic Resection Based on Lymph Node Metastasis in Ulcerative Early Gastric Cancer.

There is little evidence regarding appropriate therapeutic modalities for ulcerative-type early gastric cancer (EGC) because the risks and implications of lymph node metastasis are unclear. The indication for endoscopic submucosal dissection (ESD) was investigated for ulcerative-type EGC. We retrospectively analyzed 192 patients with differentiated ulcerative-type EGC who underwent radical gastrectomy with D2 lymph node dissection. Lymph node metastasis (LNM) risk factors were evaluated using multivariate logistic regression. The LNM rate was 15.1% overall, 0% for mucosa-confined lesions, and 28.2% for submucosa-infiltrating lesions. On multivariate analysis, only lymphovascular invasion ( < .001) was significantly associated with LNM. Among patients with minute submucosal invasion and no lymphovascular invasion, LNM was only observed for tumor sizes ≥2.1 cm. Because LNM risks are negligible, curative ESD could be considered in patients with ulcerative EGC that is confined to the mucosa and histologically differentiated, irrespective of tumor size. In addition, ESD can be attempted for ulcerative EGC with minute submucosal invasion and tumor size <2.1 cm.