Jae Jin Hwang1, Kwung Jun Park1, Young Soo Park2, Hye Seung Lee3, Hyuk Yoon1, Cheol Min Shin1, Nayoung Kim1, Dong Ho Lee1. 1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. 2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. dkree@naver.com. 3. Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Abstract
BACKGROUND: The aim of this study was to identify the risk factors for residual/recurrent tumors in patients with a tumor-positive lateral resection margin (LRM+) after endoscopic resection of early gastric cancer (EGC) and to establish the criteria for performing additional treatment. METHODS: A retrospective analysis was performed on consecutive patients who underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of EGC. Clinicopathological characteristics and risk factors for residual/recurrent tumor in LRM+ patients were analyzed. RESULTS: Eighty-two patients (84 lesions) with LRM+ after EMR (n = 45) or ESD (n = 39) were enrolled. Forty patients underwent additional gastrectomy or ESD, and 44 were closely observed. The residual/recurrent tumor rate was 34.5 % (29 of 84 lesions). Univariate analysis found that the residual/recurrent tumor was associated with the endoscopic resection type (EMR), undifferentiated histology, number of involved directions, rate of lateral resection margin involvement and the total length (mm) of the lateral resection margin involved by the tumor. In multivariate logistic regression analysis, undifferentiated histology and rate (%) were independent risk factors (odds ratio [OR] 5.28, 95 % confidence interval [CI] 1.13-24.72, p = 0.035 and OR 1.08, 95 % CI 1.03-1.14, p = 0.004, respectively). Clinicopathological factors that were identified from the univariate and multivariate analyses were scored in order to predict residual/recurrent tumors. CONCLUSION: We suggest a scoring system for additional treatment in patients with LRM+ after endoscopic resection of EGC based on the development of residual/recurrent tumors. This scoring system enables a more detailed selection of cases and may be useful in determining further treatment.
BACKGROUND: The aim of this study was to identify the risk factors for residual/recurrent tumors in patients with a tumor-positive lateral resection margin (LRM+) after endoscopic resection of early gastric cancer (EGC) and to establish the criteria for performing additional treatment. METHODS: A retrospective analysis was performed on consecutive patients who underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of EGC. Clinicopathological characteristics and risk factors for residual/recurrent tumor in LRM+ patients were analyzed. RESULTS: Eighty-two patients (84 lesions) with LRM+ after EMR (n = 45) or ESD (n = 39) were enrolled. Forty patients underwent additional gastrectomy or ESD, and 44 were closely observed. The residual/recurrent tumor rate was 34.5 % (29 of 84 lesions). Univariate analysis found that the residual/recurrent tumor was associated with the endoscopic resection type (EMR), undifferentiated histology, number of involved directions, rate of lateral resection margin involvement and the total length (mm) of the lateral resection margin involved by the tumor. In multivariate logistic regression analysis, undifferentiated histology and rate (%) were independent risk factors (odds ratio [OR] 5.28, 95 % confidence interval [CI] 1.13-24.72, p = 0.035 and OR 1.08, 95 % CI 1.03-1.14, p = 0.004, respectively). Clinicopathological factors that were identified from the univariate and multivariate analyses were scored in order to predict residual/recurrent tumors. CONCLUSION: We suggest a scoring system for additional treatment in patients with LRM+ after endoscopic resection of EGC based on the development of residual/recurrent tumors. This scoring system enables a more detailed selection of cases and may be useful in determining further treatment.
Authors: Y Seto; S Shimoyama; J Kitayama; K Mafune; M Kaminishi; T Aikou; K Arai; K Ohta; A Nashimoto; I Honda; H Yamagishi; Y Yamamura Journal: Gastric Cancer Date: 2001 Impact factor: 7.370
Authors: Jin Seok Jang; Seok Reyol Choi; Waqar Qureshi; Min Chan Kim; Su Jin Kim; Jin Sook Jeung; Sang Young Han; Myung Hwan Noh; Jong Hoon Lee; Seung Wook Lee; Yang Hyun Baek; Sung Hyun Kim; Phil Jo Choi Journal: Scand J Gastroenterol Date: 2009 Impact factor: 2.423
Authors: Jaffer A Ajani; David J Bentrem; Stephen Besh; Thomas A D'Amico; Prajnan Das; Crystal Denlinger; Marwan G Fakih; Charles S Fuchs; Hans Gerdes; Robert E Glasgow; James A Hayman; Wayne L Hofstetter; David H Ilson; Rajesh N Keswani; Lawrence R Kleinberg; W Michael Korn; A Craig Lockhart; Kenneth Meredith; Mary F Mulcahy; Mark B Orringer; James A Posey; Aaron R Sasson; Walter J Scott; Vivian E Strong; Thomas K Varghese; Graham Warren; Mary Kay Washington; Christopher Willett; Cameron D Wright; Nicole R McMillian; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2013-05-01 Impact factor: 11.908
Authors: H Isomoto; S Shikuwa; N Yamaguchi; E Fukuda; K Ikeda; H Nishiyama; K Ohnita; Y Mizuta; J Shiozawa; S Kohno Journal: Gut Date: 2008-11-10 Impact factor: 23.059