Outcome of salvage surgery for XXXX initially treated by upfront endoscopic therapy.

@entity1 @entity13849 @entity3 @entity14
BACKGROUND: Recent advances in endoscopic therapy, including conventional endoscopic resection and endoscopic submucosal dissection (ESD), have led to a large number of @entity1 with early @entity14 ( @entity14 ) being cured; however, when resected specimens obtained by these procedures manifest risk factors for lymph node @entity3 , additional treatments need to be considered. The aim of our study was to evaluate the outcomes of salvage surgery in @entity14 @entity1 treated initially by advanced therapeutic endoscopy. METHODS: We investigated 145 @entity1 who underwent salvage surgery in our department after endoscopic therapy for @entity14 between April 2006 and March 2015. Demographic and pathological data, endoscopic procedures, reasons for surgery, and operative outcomes, including perioperative details and recurrence-free and disease-specific survival after surgery, were analyzed. These data were further compared with those of 59 @entity1 with submucosal invasive @entity14 treated by conventional endoscopic resection/ESD alone and 133 @entity1 treated by surgery alone. RESULTS: Overall lymph node @entity3 were observed in 14% of @entity1 who underwent salvage surgery after therapeutic endoscopy and 16% of those who received abdominal surgery alone. In analyses of surgical cases, @entity1 with lymph node @entity3 more frequently included cases with lymphatic infiltration (63%) and ESD-treated cases (45%) than those without @entity3 (21%, P  <  .0001 and 22%, P  =  .02; respectively). A logistic regression analysis identified lymphatic infiltration as an independent predictive factor for lymph node @entity3 (odds ratio: 8.77, 95% confidence interval: 2.90-33.31, P  <  .0001). Long-term outcomes were favorable in both lymphatic infiltration-negative and positive cases. Moreover, survivals were comparable among the different treatment groups. CONCLUSION: Because of the high rate of @entity13849 involvement, adequate lymphadenectomy need to be performed in salvage surgery after upfront endoscopic therapy.
