Risk assessment of lymph node metastases in early gastric adenocarcinoma fulfilling expanded endoscopic resection criteria

Background and Aims Early gastric cancer (EGC) is known to present a low rate of lymph node metastases (LNMs). Gastrectomywith D2 lymphadenectomy is usually curative for EGC. Endoscopic submucosal dissection(ESD) is a well-accepted treatment modality for lesions that meet the classic criteria: those mucosal differentiated adenocarcinoma measuring 20 mm or less, without ulceration. Expanded criteria for ESD have been proposed based on a null LNM rate from large gastrectomyseries from Japan. Patients with LNM have been reported in Western centers, heightening the need for validation of expanded criteria. Our aim was to assess the risk of LNM in gastrectomyspecimens of patients with EGC who met the expanded criteria for ESD. Methods We conducted an evaluation of gastrectomyspecimens including LNM staging of patients submitted to gastrectomyfor EGC in a 39-year retrospective cohort. Results A total of 389 surgical specimens were included. From them, 135 fulfilled criteria for endoscopic resection. None of the 31 patients with classic criteria had LNM. From the 104 patients with expanded criteria, 3 had LNM (n = 104 [2.9%], 95% confidence interval, .7%-8.6%), all of them with undifferentiated tumors without ulceration, measuring less than 20 mm. Conclusions There is a small risk of LNM in EGC when expanded criteria for ESD are met. Refinement of the expanded criteria for the risk of LNM may be desirable in a Brazilian cohort. Meanwhile, the decision to complement the endoscopic treatment with gastrectomywill have to take into consideration the individual risk of perioperative morbidity and mortality.