{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:40:31Z","timestamp":1780544431877,"version":"3.54.1"},"reference-count":31,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The clinical significance of lymphatic invasion in mucosal early gastric cancer (EGC) treated with endoscopic submucosal dissection (ESD) remains unclear. We evaluated clinicopathologic features and long-term outcomes in patients with lymphatic invasion as the sole non-curative factor. Methods: We retrospectively reviewed 9117 patients who underwent ESD for EGC at Samsung Medical Center between 2001 and 2022. Among patients with mucosal disease and lymphatic invasion as the sole non-curative factor, long-term clinical outcomes were summarized using an outcome flowchart, and characteristics of lymph node-positive cases were analyzed in relation to curative resection criteria. Results: Among 7444 patients with mucosal EGC treated with ESD, lymphatic invasion was identified in 154 patients (2.1%). Among the 117 patients with lymphatic invasion as the sole non-curative factor, the overall rate of pathologically confirmed or clinically suspected lymph node metastasis (LNM) was 4.3% (5\/117). Specifically, LNM was identified in 3.2% (3\/95) of patients who underwent additional surgery, and in 9.0% (2\/22, including one clinically suspected case) managed with observation alone during a median follow-up of 58.0 months. LNM was observed exclusively in lesions involving the muscularis mucosae or in lesions larger than 2 cm, whereas no LNM occurred in tumors confined to the lamina propria measuring \u2264 2 cm. Conclusions: Despite mucosal confinement, lymphatic invasion was associated with a clinically meaningful risk of LNM, whereas no LNM was observed in lesions \u2264 2 cm confined to the lamina propria. For patients with mucosal EGC in whom lymphatic invasion is the sole non-curative factor, careful, individualized decision-making is warranted.<\/jats:p>","DOI":"10.3390\/cancers18101653","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T12:30:51Z","timestamp":1779280251000},"page":"1653","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Outcomes of Mucosal Early Gastric Cancer with Lymphatic Invasion as the Sole Non-Curative Factor After Endoscopic Submucosal Dissection"],"prefix":"10.3390","volume":"18","author":[{"given":"Na-Kyung","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3950-4516","authenticated-orcid":false,"given":"Tae-Se","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soomin","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Pathology and Translational Genomics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang Won","family":"Min","sequence":"additional","affiliation":[{"name":"Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4271-7205","authenticated-orcid":false,"given":"Hyuk","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Hoon","family":"Min","sequence":"additional","affiliation":[{"name":"Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Haeng","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poong-Lyul","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5230\/jgc.2025.25.e11","article-title":"Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline)","volume":"25","author":"Kim","year":"2025","journal-title":"J. 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