Background. Standard treatment of early
gastric cancer (EGC) after endoscopic resection with risk factors of nodal
metastases and incomplete resection is controversial. We investigated optimal management for the patients with potentially noncurative EGC after endoscopic resection. Methods. We retrospectively examined clinicopathological data and surgical outcomes of all patients with clinically solitary gastric
adenocarcinoma who underwent curative surgery after a single peroral endoscopic resection at the Digestive Disease Center of Showa University Northern Yokohama Hospital between April 2001 and December 2012. Fisher's exact test was used for univariate analysis. For multivariate analysis, stepwise multiple linear regression was used to identify independent predictors related to
lymph node metastasis and remnant of primary
tumor. Results. A total of 41 patients were studied. Four patients (9.8%) had
lymph node metastases. Primary
tumors remained in 6 patients (14.6%). Only venous invasion was statistically significant to
lymph node metastasis (P = 0.017). With respect to remnant of the primary
tumor, pT1b2
tumor invasion (P = 0.015) and horizontal margin (P = 0.013) were statistically significant. Conclusions. Surgery with limited
lymphadenectomy is recommended for
tumors with venous invasion or pT1b2
tumor invasion, and additional endoscopic resection may be allowed for
tumors with horizontal involvement.