Related factors of lymph node metastasis in early gastric cancer and clinical efficacy of laparoscopic D2 radical resection versus endoscopic submucosal dissection: a retrospective cohort study

Abstract

Objective To explore the related factors of lymph node metastasis in early gastric cancer and to analyze the clinical efficacy between laparoscopic D2 radical resection and endoscopic submucosal dissection (ESD). Methods A retrospective cohort study was conducted on 404 patients with early gastric cancer undergoing surgical treatment in our hospital from June 2018 to June 2022 were recruited in this study. According to their surgical treatment, they were divided into laparoscopy group (n=271) and ESD group (n=133). The lymph node metastases were compared in the patients with different clinical features, and the factors affecting lymph node metastasis were analyzed with multivariate logistic regression analysis. The lymph node metastasis rate of patients with absolute and expanded indications of ESD was calculated. Kaplan-Meier survival analysis was used to compare the long-term efficacy of ESD and laparoscopic D2 radical resection in these patients. Stratified regression analysis was applied to explore the relationship between surgical methods and long-term outcome in them. Results In the 404 patients with early gastric cancer, the rate of lymph node metastasis was 12.38% (50/404). Univariate analysis showed that 7 clinical features, such as ulcer, tumor pathological features and pathological differentiation, were related to lymph node metastasis. Multivariate logistic regression analysis revealed that low differentiation and tumor infiltration depth of submucous membrane (SM) were related factors affecting lymph node metastasis in early gastric cancer. The overall survival rate was 96.29% (389/404) in the 404 patients, 96.31% in the laparoscopic group and 96.24% in the ESD group, and no statistical difference was seen between the 2 groups (P>0.05). There was no obvious difference in 5-year survival rate between the patients who met the absolute indications for ESD and underwent laparoscopic D2 radical surgery and those receiving ESD treatment (96.00% vs 96.55%), and between those who were in accordance with the expanded indications for ESD and underwent laparoscopic D2 radical surgery and those receiving ESD treatment (94.74% vs 91.67%). After adjusting the clinical features such as lesion size, pathological differentiation and depth of tumor invasion by stratified regression analysis, the mode of operation for early gastric cancer was still correlated with the long-term efficacy (β=1.173, P=0.003). Conclusion The depth of tumor infiltration and differentiation are closely related to lymph node metastasis in early gastric cancer patients. The efficacy of laparoscopic D2 radical surgery on the patients with absolute and expanded indications for ESD is comparable to that of ESD treatment.

Keywords

• early gastric cancer
• lymph node metastasis
• laparoscopic d2 radical surgery
• endoscopic submucosal dissection