Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer?

  • Lee, Ji-Ho (Department of Surgery, Postgraduate School of Medicine, Pusan National University) ;
  • Kim, Jae-Hun (Department of Surgery, Postgraduate School of Medicine, Pusan National University) ;
  • Kim, Dae-Hwan (Department of Surgery, Postgraduate School of Medicine, Pusan National University) ;
  • Jeon, Tae-Yong (Department of Surgery, Postgraduate School of Medicine, Pusan National University) ;
  • Kim, Dong-Heon (Department of Surgery, Postgraduate School of Medicine, Pusan National University) ;
  • Kim, Gwang-Ha (Department of Internal Medicine, Postgraduate School of Medicine, Pusan National University) ;
  • Park, Do-Yoon (Department of Pathology, Postgraduate School of Medicine, Pusan National University)
  • Received : 2010.08.06
  • Accepted : 2010.10.12
  • Published : 2010.12.30
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Abstract

Purpose: Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. Materials and Methods: A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. Results: Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). Conclusions: We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.

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References

  1. Shibuya K, Mathers CD, Boschi-Pinto C, Lopez AD, Murray CJ. Global and regional estimates of cancer mortality and incidence by site: II. Results for the global burden of disease 2000. BMC Cancer 2002;2:37. https://doi.org/10.1186/1471-2407-2-37
  2. Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH. Analyses of prognostic factors and gastric cancer specific survival rate in early gastric cancer patients and Its clinical implication. J Korean Surg Soc 2003;65:309-315.
  3. Shin DW, Hyung WJ, Noh SH, Min JS. Risk factors for recurrence aft er curative surgery for early gastric cancer. J Korean Gastric Cancer Assoc 2001;1:106-112. https://doi.org/10.5230/jkgca.2001.1.2.106
  4. Shin JK, Shin YD, Yoon C, Joo HZ. Risk factors affecting lymph node metastasis and recurrence in early gastric cancer. J Korean Gastric Cancer Assoc 2001;1:119-123. https://doi.org/10.5230/jkgca.2001.1.2.119
  5. Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 1992;79:241-244. https://doi.org/10.1002/bjs.1800790319
  6. Lee JH. Endoscopic resection of early gastric cancer in Korea: recent results and future directions. J Korean Gastric cancer Assoc 2009;9:39-45. https://doi.org/10.5230/jkgca.2009.9.2.39
  7. Kida M, Tanabe S, Saigenji K. Enodscopic mucosal resection for gastric cancer: necessity of 'Incision and Stripping Method' and present status. Dig Endosc 2003;15(Suppl 1):S15-S18. https://doi.org/10.1046/j.1443-1661.15.s.5.x
  8. Takeshita K, Tani M, Inoue H, Saeki I, Hayashi S, Honda T, et al. Endoscopic treatment of early oesophageal or gastric cancer. Gut 1997;40:123-127. https://doi.org/10.1136/gut.40.1.123
  9. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000;3:219-225. https://doi.org/10.1007/PL00011720
  10. Japanese Gastric Cancer Association, ed. Treatment Guideline for Gastric Cancer in Japan. 2nd ed. Tokyo: Kanehara, 2004.
  11. Nagano H, Ohyama S, Fukunaga T, Seto Y, Fujisaki J, Yamaguchi T, et al. Indications for gastrectomy after incomplete EMR for early gastric cancer. Gastric Cancer 2005;8:149-154. https://doi.org/10.1007/s10120-005-0328-5
  12. Chung YS, Park DJ, Lee HJ, Kim SG, Jung HC, Song IS, et al. Th e role of surgery aft er incomplete endoscopic mucosal resection for early gastric cancer. Surg Today 2007;37:114-117. https://doi.org/10.1007/s00595-006-3328-0
  13. Maehara Y, Kakeji Y, Oda S, Takahashi I, Akazawa K, Sugimachi K. Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancer. Br J Cancer 2000;83:986-991. https://doi.org/10.1054/bjoc.2000.1427
  14. Korean Gastric Cancer Association. Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc 2002; 2:105-114. https://doi.org/10.5230/jkgca.2002.2.2.105
  15. Oda I, Gotoda T, Sasako M, Sano T, Katai H, Fukagawa T, et al. Treatment strategy aft er non-curative endoscopic resection of early gastric cancer. Br J Surg 2008;95:1495-1500. https://doi.org/10.1002/bjs.6305
  16. Ryu KW, Choi IJ, Doh YW, Kook MC, Kim CG, Park HJ, et al. Surgical indication for non-curative endoscopic resection in early gastric cancer. Ann Surg Oncol 2007;14:3428-3434. https://doi.org/10.1245/s10434-007-9536-z
  17. Song KY, Hyung WJ, Kim HH, Han SU, Cho GS, Ryu SW, et al; Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multi-center study. J Surg Oncol 2008;98:6-10. https://doi.org/10.1002/jso.21074
  18. Korenaga D, Orita H, Maekawa S, Maruoka A, Sakai K, Ikeda T, et al. Pathological appearance of the stomach aft er endoscopic mucosal resection for early gastric cancer. Br J Surg 1997;84:1563-1566. https://doi.org/10.1002/bjs.1800841120
  19. Chang JH, Lee IS, You CR, Nam KW, Kwon JH, Suh JP, et al. Re-endoscopic mucosal resection for a residual or locally recurrent gastric lesion after endoscopic mucosal resection. Korean J Gastrointest Endosc 2007;35:6-13.
  20. Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T, et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006;9:262-270. https://doi.org/10.1007/s10120-006-0389-0

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