An Investigation of Patients who have Undergone Curative Gastrectomy after Incomplete Endoscopic Mucosal Resection with a Diagnosis of Early Gastric Cancer

ABSTRACT

PURPOSE: Increasingly, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has been performed. However, yet, there is no standard therapy after incomplete EMR or ESD. The aim of this study was to evaluate the necessity of further resection after an incomplete EMR or ESD. METHODS: We analyzed 24 patients who underwent curative gastrectomy due to an incomplete EMR or ESD between January 2000 and February 2007. A retrospective review was performed evaluating the clinicopathological characteristics, operating methods and presence of residual tumor. RESULTS: After the gastrectomy, the total positive residual tumor rate was 66.7% (16/24), with a rate of 73.5% (11/15) for mucosal cancer a rate of 50.0% (4/8) for submucosal cancer, and a rate of 100% (1/1) for cancer that invaded the muscularis propria. There were no positive lymph nodes. There was no recurrence in a mean 35.5 months (range, 4~90 months) of follow-up. CONCLUSION: Further resection is recommended for patients with a positive resection margin, because of the possibility of the presence of a residual tumor. Laparoscopic resection may be one of the most effective therapeutic options for these patients as a minimally invasive procedure by which curative resection can be expected.