Defining a Subgroup Treatable for Laparoscopic and Endoscopic Cooperative Surgery in Undifferentiated Early Gastric Cancer: the Role of Lymph Node XXXX .

@entity1 @entity5 @entity356 @entity3
BACKGROUND: Recently, the use of endoscopic submucosal dissection (ESD) for @entity356 ( @entity356 ) and the development of laparoscopic and endoscopic cooperative surgery (LECS) have enabled either the preservation of the stomach or the minimization of the extent of partial resection. ESD has recently been practiced on a differentiated type of @entity356 . However, there is no clear evidence for endoscopic treatments of undifferentiated @entity356 . The purposes of this study are to investigate predictive factors of lymph node @entity3 (LNM) in undifferentiated @entity356 and expand the possibility  of using LECS for the treatment of undifferentiated @entity356 . METHODS: Data from 116 @entity1 with undifferentiated @entity356 and surgically treated were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95  % confidence interval (95  % CI) were calculated. RESULTS: The @entity5 size (OR   =   11.748, 95  % CI 2.034-62.213, P   =   0.008), depth of invasion (OR   =   13.928, 95  % CI 1.971-92.434, P   =   0.016), and lymphatic vessel involvement (OR   =   11.522, 95  % CI 2.645-59.172, P   =   0.021) that were significantly associated with LNM by univariate analysis were found to be significant and independent risk factors for LNM by multivariate analysis. The LNM rate was 5.9  % (4/68) and 29.2  % (14/48) with intramucosal and submucosal undifferentiated @entity356 , respectively. LNM was observed in 66.7  % (2/3) of @entity1 with both risk factors ( @entity5 larger than or equal to 2.0  cm and the presence of lymphatic vessel involvement (LVI)), but in none of 36 @entity1 without the two risk factors in intramucosal undifferentiated @entity356 . The 5-year survival rates were 88.9, 72.4, and 33.3  %, respectively, in cases with none, one, and two of the risk factors, respectively, in intramucosal undifferentiated @entity356 (P   <   0.05). CONCLUSIONS: ESD alone may be a sufficient treatment for intramucosal undifferentiated @entity356 if the @entity5 is less than 2.0  cm in size and when LVI is absent upon postoperative histological examination. LECS is feasible and safe for @entity1 with undifferentiated @entity356 .
