WITHDRAWN: Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with ulcerative-type early gastric cancer

Abstract

Background: There is little evidence regarding the appropriate therapeutic modalities for ulcerative-type early gastric cancer (EGC) because the risks and implications of lymph node metastasis (LNM) are unclear. In this study, the indication for endoscopic submucosal dissection (ESD) was investigated in patients with ulcerative-type EGC. Results: The overall LNM rate was 15.1%, 0% for mucosa-confined lesions, and 28.2% for submucosa-infiltrating lesions. In the multivariate analysis, only lymphovascular invasion (P < 0.001) was significantly associated with LNM. Among patients with minute submucosal invasion and no lymphovascular invasion, LNM was only observed in patients with tumor sizes > 2.0 cm. Materials and Methods: We retrospectively analyzed 192 patients with ulcerativetype EGC who underwent radical gastrectomy with D2 lymph node dissection. The LNM risk factors were evaluated using a multivariate logistic regression analysis. Conclusions: Because the LNM risks are negligible, curative ESD could be considered in patients with ulcerative EGC that is confined to the mucosa and histologically differentiated, irrespective of tumor size. Additionally, ESD can be attempted in patients with ulcerative EGC with minute submucosal invasion and a tumor size ≤ 2.0 cm.