Introduction: Endoscopic resection (ER) of early gastric cancer (EGC) is increasingly used in Eastern countries due to their low rates of lymph node metastasis (LNM); however, there is a paucity of evidence in Western countries. We investigated LNM and its effect on overall survival (OS) in Western patients with EGC.Methods: Patients diagnosed with T1 gastric cancer between 2000 and 2017 were retrospectively evaluated. Univariate Kaplan-Meier, multivariate logistic and Coxregression models were used to assess the associations between clinical characteristics, LNM, and OS.Results: Among 86 patients, median age was 68 years and 72% were male. Node positivity was 30%. Two percent of patients met the classical guidelines for ER and all were node-negative, while 16% met expanded criteria of which 14% were nodepositive. T1b disease (odds ratio [OR] 41.2 [95% confidence interval [CI] 1.62-1048], p = 0.02) and lymphovascular/perineural invasion (OR 18.0 [95% CI 2.41 -134], p = 0.01) were predictive of node positivity. The 5-year OS for nodenegative and node-positive patients was 84% and 53% (p = 0.004), respectively. Conclusions:The risk of LNM in Western patients with EGC is higher; therefore, generalizability of the expanded criteria for ER should be interpreted with caution.

Background Surveillance guidelines following the resection of small bowel neuroendocrine tumors (SB‐NETs) are inconsistent. We evaluated the impact of surveillance imaging on SB‐NET recurrence and overall survival (OS). Methods Patients with completely resected SB‐NETs referred to a provincial cancer center (2004–2015) were reviewed. Associations between imaging frequency, recurrence, post‐recurrence treatment, and OS were determined using univariate and Cox‐regression analyses. Results Among 195 completely resected SB‐NET patients, 31% were ≥70 years, 43% were female, and 80% had grade 1 disease. Imaging frequency was predictive of recurrence (hazard ratio 2.52, 95% confidence interval 1.84–3.46, p < 0.001). 72% underwent interventions for recurrent disease. Patients who were treated for the recurrent disease had comparable OS to those who did not recur (median 152 vs. 164 months; p = 0.25). Imaging frequency was not associated with OS in those with treated recurrent disease (p = 0.65). Patients who recurred underwent more computerized tomography (CT) scans than those who did not recur (CT: 1.47 ± 0.89 vs. 1.02 ± 0.81 scans/year, p < 0.001). Detection of disease recurrence was 5%–7% per year during the first 6 years of surveillance and peaked at 17% in Year 9. Conclusion Less frequent imaging over a longer duration should be emphasized to capture clinically relevant recurrences that can be treated to improve OS.