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Korean Journal of Clinical Oncology > Article
Korean J Clin Oncol. 2010;6(1): 27-32.         doi: https://doi.org/10.14216/kjco.10004
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
박지혜, 김용진, 조주영, 강길호, 정귀애, 조규석, 이문수, 허경열, 김재준
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
Received: May 20, 2010;  Accepted: June 23, 2010.
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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.
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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