PURPOSE: Endoscopic mucosal resection (EMR) is a relatively new treatment option for early gastric cancer (EGC). However, cases of incomplete EMR resulting in a positive lateral margin or submucosal invasion (positive vertical margin) have been reported. We conducted this study to evaluate the role of surgery after incomplete EMR for EGC. METHODS: We analyzed 19 patients who underwent gastrectomy as a result of an incomplete EMR. The patients were divided into three groups according to the type of incomplete EMR: a positive lateral margin (LM) group (n = 9), a positive vertical margin (VM) group (n = 4), and a positive lateral and vertical margin (LM + VM) group (n = 6). RESULTS: The positive residual tumor rate and the positive lymph node rate were 44.4% (4/9) and 0% (0/9) in the LM group, 50.0% (2/4) and 25.0% (1/4) in the VM group, and 83.3% (5/6) and 16.7% (1/6), LM + VM group, respectively. Curative resection was performed in all patients and there was no recurrence in 30.8 months of follow-up. CONCLUSION: Radical surgery is recommended for patients with a positive lateral resection margin or submucosal invasion, or both, after EMR for EGC, because of the possibility of residual tumor or lymph node metastasis.
PURPOSE: Endoscopic mucosal resection (EMR) is a relatively new treatment option for early gastric cancer (EGC). However, cases of incomplete EMR resulting in a positive lateral margin or submucosal invasion (positive vertical margin) have been reported. We conducted this study to evaluate the role of surgery after incomplete EMR for EGC. METHODS: We analyzed 19 patients who underwent gastrectomy as a result of an incomplete EMR. The patients were divided into three groups according to the type of incomplete EMR: a positive lateral margin (LM) group (n = 9), a positive vertical margin (VM) group (n = 4), and a positive lateral and vertical margin (LM + VM) group (n = 6). RESULTS: The positive residual tumor rate and the positive lymph node rate were 44.4% (4/9) and 0% (0/9) in the LM group, 50.0% (2/4) and 25.0% (1/4) in the VM group, and 83.3% (5/6) and 16.7% (1/6), LM + VM group, respectively. Curative resection was performed in all patients and there was no recurrence in 30.8 months of follow-up. CONCLUSION: Radical surgery is recommended for patients with a positive lateral resection margin or submucosal invasion, or both, after EMR for EGC, because of the possibility of residual tumor or lymph node metastasis.
Authors: S Ohashi; K Segawa; S Okamura; M Mitake; H Urano; M Shimodaira; T Takeda; S Kanamori; T Naito; K Takeda; B Itoh; H Goto; Y Niwa; T Hayakawa Journal: Gut Date: 1999-10 Impact factor: 23.059
Authors: Kenji Shibuya; Colin D Mathers; Cynthia Boschi-Pinto; Alan D Lopez; Christopher J L Murray Journal: BMC Cancer Date: 2002-12-26 Impact factor: 4.430
Authors: Geum Youb Noh; Ha Ra Ku; Youn Joo Kim; Su Cheol Park; Jin Kim; Chul Ju Han; Yu Chul Kim; Ki Young Yang Journal: Surg Endosc Date: 2014-12-06 Impact factor: 4.584
Authors: Ji Ho Lee; Jae Hun Kim; Dae Hwan Kim; Tae Yong Jeon; Dong Heon Kim; Gwang Ha Kim; Do Yoon Park Journal: J Gastric Cancer Date: 2010-12-31 Impact factor: 3.720