Risk Factors for Lateral Margin Positivity Following Endoscopic Submucosal Dissection in Patients with Early Gastric...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Positive lateral margins (LM+) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) can result in residual disease.
• Subepithelial (SE) spread beneath normal mucosa is a potential, yet unconfirmed, cause of LM+.

Purpose of the Study:

• To investigate the association between subepithelial (SE) spread and lateral margin positivity (LM+) in early gastric cancer (EGC) after endoscopic submucosal dissection (ESD).
• To identify predictors of LM+ in EGC patients undergoing ESD.

Main Methods:

• Retrospective review of 248 EGC patients who underwent ESD (21 LM+ cases, 227 LM- controls).
• Comparison of clinicopathologic and endoscopic factors.
• Multivariate logistic regression analysis to identify LM+ predictors.
• Pathological evaluation of SE spread extent.

Main Results:

• Lesion size ≥ 2 cm was the sole independent predictor of LM+.
• SE spread length was significantly greater in LM+ cases (5.80 mm) compared to controls (2.60 mm).
• SE spread ≥ 5 mm markedly increased LM+ risk (OR 15.077).

Conclusions:

• Subepithelial (SE) spread, especially ≥ 5 mm, may obscure tumor boundaries, contributing to lateral margin positivity (LM+) in EGC.
• Consideration of wider marking and resection margins is advised for EGC lesions with features suggesting SE spread.