Feasibility of Endoscopic Resection in Early Gastric Cancer with Lymphovascular Invasion

Background: Lymphovascular invasion (LVI) is associated with the risk of lymph node metastasis (LNM) and poor survival in gastric cancer patients; however, it is unclear whether LVI is a non-curative criteria component in all patients. We evaluated the risk factors of LNM in LVI-positive early gastric cancer (EGC) patients and identified a subgroup with a negligible LNM risk to assess the feasibility of endoscopic resection in these patients. Methods: The clinicopathologic and survival data of patients undergoing surgery for gastric cancer were reviewed; LVI-positive EGC patients were selected. Logistic regression analysis was used to test the associations of potential risk factors with LNM, and Kaplan–Meier analysis was used to compare survival curves. Results: LVI was detected in 1243 (15.5%) patients. In the multivariate logistic analysis, larger tumor size (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.16–1.31; p < 0.001), presence of ulcer (OR 1.80, 95% CI 1.15–2.82; p = 0.010), undifferentiated histology (OR 1.64, 95% CI 1.25–2.16; p < 0.001), submucosal invasion (OR 2.28, 95% CI 1.38–3.76; p = 0.001), middle (OR 2.12, 95% CI 1.26–3.55; p = 0.004) or lower third location (OR 2.28, 95% CI 1.32–3.60; p = 0.002), and younger age (OR 0.98, 95% CI 0.97–0.99; p = 0.002) independently predicted LNM in LVI-positive EGC patients. LVI-positive patients fulfilling the absolute endoscopic resection criteria did not have LNM and there was no significant difference in the overall (p = 0.928) and disease-specific survival (p = 0.821) between these patients and those with LVI-negative EGC. Conclusions: Additional surgery after endoscopic resection might be unnecessary in LVI-positive patients meeting the absolute criteria for endoscopic resection.