The optimal time of additional surgery after non-curative endoscopic submucosal dissection in eCura-C2 gastric cancer patients

Early gastric cancer (EGC) patients who undergo non-curative endoscopic submucosal dissection (ESD) require additional surgery. The aim of this study was to investigate the optimal time of additional surgery in EGC patients with an endoscopic curability C-2 (eCura-C2) indication. A retrospective study was conducted in EGC patients with an eCura-C2 indication from March 2011 to December 2019. A total of 105 patients were included. According to the time of additional surgery, they were divided into two groups: early surgery group (1–29 days, n = 72) and delayed surgery group (30–90 days, n = 33). We retrospectively compared the clinical characteristics, surgical safety, complications, and outcomes between the two groups. No statistically significant differences in baseline characteristics were observed between the two groups. The early surgery group showed more intraoperative blood loss than the delayed surgery group (168.2 ± 106.9 mL vs. 126.1 ± 71.1 mL, P = 0.042). No significant differences were observed in operation time, postoperative hospital stay, and incidence of complications. Kaplan–Meier curves showed no significant differences in 5-year overall survival (OS) and in the incidence of recurrence (time to recurrence) between the two groups. There was no significant difference in the rate of lymph node metastasis (8.3% in the early surgery group vs. 12.1% in the delayed surgery group, P = 0.539). Logistic regression analysis suggested that lymphovascular invasion was associated with lymph node metastasis in eCura-C2 patients (OR = 6.917, 95% CI: 1.741–27.479, P = 0.006). No statistically significant difference in oncological outcomes was detected between early and delayed additional surgery in this small, retrospective cohort, which was underpowered to establish equivalence. Early surgery was associated with greater intraoperative blood loss. The timing of additional surgery should be individualized based on tumor characteristics, patient condition, and patient preference, and warrants further investigation in larger prospective studies.