Risk Factors For Additional Surgery And Risk Of Lymph Node Metastasis In Patients With Early Gastric Cancer After ESD

Objective:To investigate the risk factors and lymph node metastasis risk of non-cure resection after endoscopic submucosal dissection(ESD)in patients with early gastric cancer.Methods:In this study,the clinical and pathological data of 122 patients with early gastric cancer(ECC)from June 2016 to December 2018 in Qilu Hospital of Shandong University were retrospectively analyzed.Patients were divided into ESD groups according to different surgical methods.=43)and ESD postoperative surgery group(n=29)and surgery group(n=50),ESD group patients only under ESD treatment,postoperative pathological results meet the criteria of curative resection,no additional surgical treatment;Patients in the surgical group underwent direct gastrectomy plus D2 lymph node dissection.Patients in the additional surgery group after ESD were treated with ESD.The pathology after ESD did not meet the absolute and relative curative resection indications for ESD resection.Because of the high risk of postoperative recurrence,and the second-stage additional gastrectomy plus D2 lymph node dissection,a total of 122 patients were included.The oncological features,hospitalization,and intraoperative parameters were analyzed and compared using SPSS 25.0 software.data analysis.P<0.05 indicates that the difference is statistically significant.Results:The risk factors for additional surgery for non-cure resection after ESD in patients with early gastric cancer were related to tumor invasion of the submucosa(p<0.001)and poor type of tumor differentiation(p=0.009),while the patient's age,gender,tumor location,tumor diameter There were no significant differences in the morphological classification,whether there were ulcers and whether there were vascular invasions in the tumors.There was no significant difference between the additional surgery group and the ESD group after ESD(p>0.05).The completeness of the margin or basal of ESD was closely related to the tumor infiltrating submucosa(p<0.001).The patients in the additional surgery group after ESD were compared with the two groups in the surgical group.The surgical procedure,operation time,intraoperative blood loss,number of lymph node dissection,lymph node metastasis rate,postoperative fever or infection rate were compared between the two groups.There were no significant differences in postoperative gastrointestinal decompression time,postoperative anastomotic leakage rate,and postoperative hospital stay(p>0.05).Conclusion:Tumor invasion of the submucosa and poor differentiation type are risk factors for additional surgery in patients after ESD.The completeness of the margin or basal of ESD is closely related to the submucosal surface of the tumor,and there is no negative impact on the subsequent surgical treatment of early gastric cancer after ESD treatment.