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KMID : 1188520100060010027
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Korean Journal of Clinical Oncology
2010 Volume.6 No. 1 p.27 ~ p.32
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Surgical Strategies after Incomplete Endoscopic Resection in Early Gastric Cancer
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Park Ji-Hyae
Kim Yong-Jin
Kang Gil-Ho
Jeong Gui-Ae
Cho Gyu-Seok
Lee Moon-Soo
Hur Kyung-Yul
Kim Jae-Joon
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Abstract
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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.
Conclusion: 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.
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KEYWORD
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Stomach cancer, Endoscopic mucosal resection, Gastrectomy
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