Clinical Analysis Of Influencing Factors Of Complete Resection In Early Gastric Cancer With Endoscopic Submucosal Dissection

Objective To discuss the influencing factors of complete resection in early gastriccancer(EGC) with endoscopic submucosal dissection(ESD), and to provide reliableevidence for the treatment of EGC.Methods we assessed prospectively the endoscopic features of66EGCs thatunderwent surgical surgery or ESD in our hospital from2010to2012, including thelesion size, presence or absence of ulceration, horizontal extent of the EGC, histologicaltype, and invasion depth, then in comparison with postoperative pathologic findings andanalysed these influencing factors.Results The morphology of the high grade intraepithelial neoplasia(HGIEN) groupand the intramucosal carcinoma(MC) group were mainly the type II（76.9%,87.9%）,The lesion size were mainly less than30mm(90.9%,88.5%)，but the morphology of thesubmucosal carcinoma(SMC) group were the type III（57.1%），and57.1%of the groupSMC were more than30mm. It demonstrated a significant difference between threegroups(P<0.005). Of14EGCs with ulceration,7cases underwent ESD successfully,and the dissected or basal margin had no residual tumor cells confirmed pathologically.Besides, all7cases treated by operation showed no tumor cells infiltration and lymphnode metastasis. Of45EGCs with ESD, the underestimation rate for entire marginsdetermined by magnifying endoscopy with narrow-band imaging(ME-NBI) wasapparently lower than that of conventional endoscopy and chromoendoscopy(2.2%VS15.6%P<0.025). The diagnostic accuracy for histological type by conventionalendoscopy was as high as93.9%(31/32, P>0.1), but it demonstrated that we wereunable to identify differentiated and undifferentiated cancer by ME-NBI. The correctdiagnosis of the group HGIN was28cases, that of the group M was15, that of thegroup SM was5. The sensitivity, specificity of the group HGIN were84.8%,72.7%, whereas those for the group M and SM were57.7%,92.5%and71.4%,91.5%respectively. It demonstrated a significant difference between the group HGIEN andMC(P<0.05), with no significant difference between the group HGIEN and SMC, MCand SMC (P>0.5).Conclusions The lesion that≥30mm, presence of ulceration, underestimation of theborder, undifferentiated carcinoma, deep infiltration of suspicious lesions are theinfluence factors of incomplete resection of EGC. It is important to preoperativelyassess the factors and strictly grasp the indication for ESD, avoiding unnecessaryoperative treatment.