135P - Significance of lymphatic invasion in the indication for additional gastrectomy after endoscopic treatment

Background

In latest Japanese guidelines for gastric cancer treatment, the curability of endoscopic resection of patients with lymphovascular invasion (LVI) is classified as C-2 regardless of the presence or absence of other risk factors, and the standard therapy for C-2 is additional radical resection. On the other hand, pathological diagnosis after additional resection is often diagnosed as pN0, resulting in over treatment. The aim of this study was to investigate the clinical significance of LVI in the indication of endoscopic resection for gastric cancer, and also to evaluate the recently proposed stratification using the eCura system, a new scoring system for post-ESD curability of early gastric cancer.

Methods

A total of 164 patients who underwent additional surgical resection after endoscopic resection were enrolled in this study. The correlation between LVI and pathological lymph node metastasis was investigated and compared with the eCura system score.

Results

Patients with LVI positive (LVI (+)) were 64, and 100 were LVI negative (LVI (-)). Only 12 (7.3%) had lymph node metastasis, 8 (12.5%) in the LVI (+) and 4 (4.0%) in the LVI (-) (p = 0.04). In 9 cases, additional resection was indicated only by LVI, and none of the lymph node metastases was observed. The risk assessment using eCura system for all cases were low / intermediate / high risk: 103 (62.8%) / 42 (25.6%) / 19 (11.6%). The positive rate of lymph node metastasis was 4 (3.9%) / 4 (9.5%) / 4 (21.1%) respectively. Of the 9 cases resected by LVI alone, there were no cases classified as high risk.

Conclusions

Indications for additional surgical resection based on LVI alone are likely to be over treatment, and in such cases, careful judgment is required with reference to evaluation by the eCura system.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.