| Surgical Strategies after Incomplete Endoscopic
Resection in Early Gastric Cancer |
| Ji Hyae Park, Yong Jin Kim, Joo Young Cho, Gil Ho Kang, Gui Ae Jeong, Gyu Seok Cho, Moon Soo Lee, Kyung Yul Hur, Jae Joon Kim |
| Department of Surgery, Soonchunhyang University College of Medicine |
| 조기위암에서 불완전 내시경 절제 후의 수술 전략 |
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박지혜, 김용진, 조주영, 강길호, 정귀애, 조규석, 이문수, 허경열, 김재준 |
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순천향대학교 의과대학 외과학교실 |
| Corresponding Author:
Yong Jin Kim ,Tel: +82-2-709-9479, Fax: +82-2-795-1687, Email: yjkim@hosp.sch.ac.kr;yjgs1997@gmail.com |
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Received: May 20, 2010; Accepted: June 23, 2010. |
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| ABSTRACT |
Background: Treatment individualization and minimal invasiveness are main current issues in the management of
early gastric cancer, along with increased incidence of the disease in Korea. Although several controversies
remain, it is technically feasible to extend the indications for ESD. We intended to clarify the clinico-pathologic
characteristics and the optimal management for incompletely resected gastric cancer with endoscopic treatment.
Patients and Methods: Sixty-three patients with early gastric cancer were treated with surgery after endoscopic
resection between 1999 and 2006. The resection method, rate of en-block resection, reasons for surgery, and
pathologic results (presence of residual cancer, depth of invasion, differentiation and lymph node metastasis) were
retrospectively analyzed.
Results: En-block resection was attempted in 80% of the patients, with 56% EMR and 44% ESD. The reasons for
surgery were positive resection margin (44%), submucosal invasion or poorly differentiated cancer (30%), EMR or
ESD related complications (14%) and miscellaneous (11%). Of 54 patients (except for the patients with
complications), we observed 20 patients (37%) with residual cancer, 28 (52%) with submucosal involvement and
3(6%) with lymph node metastasis. Among 22 patients with negative resection margins, 5 (23%) had residual
cancer. For patients with positive lateral margin, there was no lymph node metastasis. The median survival time
was 23 months and all patients are still alive in a disease-free state, with excluding 7 patients who were lost to
follow-ups.
Conclusions: Although majority of the patients were diagnosed as stage IA, extending the indications for
endoscopic resection should be carefully considered, due to relatively high rate of submucosal involvement and
the presence of residual cancer with negative resection margin. However, in selected cases with positive lateral
margin or well differentiated submucosal cancer, D1 lymphadenectomy could be an alternative treatment strategy. |
| Keywords:
Stomach cancer | Endoscopic mucosal resection | Gastrectomy |
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