| Background and Aims: In China,the morbidity of gastric cancer is high and its prognosis is poor,while the diagnostic rate of early gastric cancer(EGC)is less than 10%.The rate of non-curative resection increased with the enlargement of endoscopic submucosal dissection(ESD)indications for EGC,and it is important to assess the risk s of non-curative resection before ESD.Therefore,we aim to analyze the differences between curative and non-curative endoscopic resection of EGC and to reduce the rate of non-curative endoscopic resection.Materials and Methods: We retrospectively analyzed the clinicopathological features of 147 patients with EGC(including high-grade intraepithelial neoplasia,HGIN),and they were treated by ESD in the digestive endoscope center of our hospital from January 2014 to June 2019.Criteria of curative resection: en bloc resection,negative margins,no vascular invasion and differentiated type without ulcer or ≤3cm with ulcer in mucosa,or undifferentiated type ≤2cm without ulcer in mucosa,or differentiated type ≤3cm in submucosal(<500μm).The follow-up time was at least 6 months.Results: A total of 161 lesions from 147 patients were collected.Their mean age was 61.3 years old and in cluding 115 males.One third of patients were infected with Helicobacter pylori(Hp),and patients had clinical symptoms such as abdominal pain(39.5%)and abdominal distension(23.8%).EGC mainly occurred in lesser curvature(43.5%),antrum(40.4%),cardia/fundus(29.2%),and posterior wall(27.9%).Most of lesions were single(91.9%)flat type(90.7%)with surface redness(74.5%)and ≤ 2cm in diameter(60.2%),and 0-IIa+0-IIc type was the most one among the flat types.We observed more than 95% of lesions with irregular/missing microvascular and microsurface structure,and with clear demarcation line s by narrow band imaging-magnifying endoscopy(NBI-ME).The pathological results showed that 94.4% of the lesions were undifferentiated carcinoma and 88.2% were in mucosa.Tubular/papillary adenocarcinoma(44.1%)and HGIN(39.8%)were more common in histological types,and the surrounding mu cosa of lesions often showed atrophy /intestinal metaplasia(85.1%).The histological type coincidence rate of the lesions before and after ESD was only 39.1%,and more than 50% of the lesions underestimated the pathological grade before ESD.The local recurrence rate of EGC was 1.5% in curative resection group,and its synchronous/metachronous cancer incidence and mortality were 0.8%.In non-curative resection group,t umor residual and lymph node metastasis were not found in surgery group,and cases of tumor recurrence and death were not found in follow-up group.In this study,the non-curative resection rate was 9.9%.There were significant differences in Hp infection,chest pain/tightness,undifferentiated carcinoma and lesions with white surface between curative and non-curative resection of EGC(P<0.05).Conclusion: Most of the patients with EGC were male.Lesions often were located in antrum,cardia/fundus,posterior wall,and lesser curvature.They were usually single 0-IIa+0-IIc type lesions with red surface.We observed the microvascular and microsurface structure of lesions were irregular/missing and demarcation line s were clear by NBI-ME.The histological types were mostly tubular/papillary carcinoma and HGIN.Lesions usually were differentiated carcinoma in mucosa,and the surrounding mucosa often show ed atrophy/intestinal metaplasia.The histological type coincidence rate of the lesions before and after ESD was low,and it was easy to underestimate the level of pathology before ESD.In this study,there were four main risk factors for non-curative resection: Hp infection,chest pain /tightness,white surface,and undifferentiated carcinoma.We should pay more attention on the risk factors of non-curative resection before ESD,it may be beneficial to increase the curative resection rate of EGC. |
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