Risk factors for unfavorable outcomes after endoscopic removal of submucosal invasive XXXX .

@entity1 @entity5 @entity3 @entity14 @entity204
BACKGROUND _ AIMS: Oncologic surgery is recommended after endoscopic resection of submucosal invasive T1 @entity14 if @entity1 are considered to be at high risk for @entity5 recurrence or @entity3 . However, there are sparse data on the outcome of high-risk @entity1 treated only by endoscopy. METHODS: Data were collected from 474 @entity1 who underwent endoscopic resection for T1 @entity14 from 1974-2002 at Neuperlach Hospital in Munich, Germany. @entity1 files were reviewed, and @entity1 or referring physicians were contacted to assess outcomes during a follow-up period of at least 24 months (n = 390). Histopathology and endoscopy factors associated with an unfavorable outcome (local recurrence of @entity5 , @entity3 , or @entity204 from @entity14 ) were assessed. RESULTS: Of the 390 @entity1 followed, 141 received oncologic surgery, and 249 did not; overall, 10% had an unfavorable outcome (39/390). Multivariate regression analysis revealed that lymphatic vessel infiltration, poor grading of @entity5 stage, and incomplete endoscopic resection were risk factors for unfavorable outcomes (odds ratios, 7.8, 3.4, and 2.6, respectively). If these risk factors were applied to @entity1 who did not receive oncologic surgery, negative predictive values for an unfavorable outcome were 94.6% for lymphatic vessel infiltration, 94.2% for poor grading of @entity5 stage, and 96.5% for incomplete endoscopic resection; positive predictive values were 44.4%, 42.9%, and 19.6%, respectively. CONCLUSIONS: Tumor infiltration of lymphatic vessels is the greatest risk factor for an unfavorable outcome after endoscopic resection for @entity14 . However, its positive predictive value is low. The decision to perform surgery after endoscopic resection of T1 @entity14 should be made on the basis of specific features of each @entity1 .
