Management of patients who had undergone non-curative endoscopic submucosal dissection (ESD)/endoscopic mucosal resection (EMR) for early gastric cancer

According to the guidelines established by the Japanese Gastric Cancer Association and Japan Gastroenterological Endoscopy Society, radical surgery is recommended for all patients who underwent non-curative endoscopic submucosal dissection (ESD)/endoscopic mucosal resection (EMR) for early gastric cancer (EGC) because of the potential risk of lymph node metastasis (LNM). However, 29-70％ of patients who underwent non-curative ESD/EMR have been followed up with no additional treatment. In addition, the rate of LNM among patients who underwent radical surgery after non-curative ESD/EMR is 4-11％ . The strongest independent risk factor for LNM in patients who underwent non-curative ESD is lymphatic invasion, and there are other independent risk factors such as venous invasion as well. We previously reported a simple scoring system for predicting LNM in patients who underwent non-curative ESD, which may provide useful information in clinical practice. Meanwhile, patients with gastric cancer have become older. Thus, the establishment of a prognostic model for predicting overall survival including cancer-related mortality in elderly patients who underwent non-curative ESD/EMR is required.