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What are the risk factors for residual tumor cells after endoscopic complete resection in gastric epithelial neoplasia?

Authors
 Gak Won Yun  ;  Jie-Hyun Kim  ;  Yong Chan Lee  ;  Sang Kil Lee  ;  Sung Kwan Shin  ;  Jun Chul Park  ;  Hyun Soo Chung  ;  Jae Jun Park  ;  Young Hoon Youn  ;  Hyojin Park 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.29(2) : 487-492, 2015 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2015
MeSH
Adenoma/diagnosis ; Adenoma/epidemiology ; Adenoma/surgery* ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrectomy/methods* ; Gastric Mucosa/pathology* ; Gastroscopy ; Humans ; Incidence ; Laparoscopy/methods* ; Male ; Middle Aged ; Neoplasm Grading* ; Neoplasm, Residual ; Postoperative Period ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/diagnosis ; Stomach Neoplasms/epidemiology ; Stomach Neoplasms/surgery*
Keywords
Endoscopic resection ; Gastric epithelial neoplasia ; Residual tumors ; Risk factors
Abstract
BACKGROUND: In early gastric cancer (EGC) and gastric adenoma, residual tumors may develop despite complete endoscopic resection (ER). To improve the chance of curative resection, we investigated the risk factors of residual tumor development in completely resected gastric epithelial neoplasia after ER. METHODS: In total, 3,879 gastric epithelial neoplasms showing complete resection after ER were examined; 46 (1.2 %) residual tumors were found upon follow-up endoscopy. Clinicopathological characteristics were evaluated between those with and without residual tumors. RESULTS: For gastric adenoma, high-grade dysplasia and severe intestinal metaplasia (IM) in the background mucosa were significantly associated with residual tumors. For EGC, poorly differentiated adenocarcinoma (PD), signet ring cell carcinoma (SRC), having a minimum lateral safety margin of <3 mm, and localization in the upper third of the stomach were significantly associated with residual tumors. Multivariate analysis revealed that a lateral safety margin of <3 mm (OR 13.8; p < 0.001), PD (OR 16.3; p = 0.014), and SRC (OR 9.8; p = 0.009) among EGC patients, and severe IM in the background mucosa (OR 9.0; p = 0.024) among gastric adenoma patients, were significantly associated with residual tumors. CONCLUSIONS: For neoplasms with undifferentiated histology (PD or SRC), short-term endoscopic follow-up may help to detect residual tumors that form after complete resection via ER. For EGC, the lateral margin may be considered safe if greater than 3 mm. However, the possibility of satellite lesions should be investigated when the gastric adenoma to be resected is surrounded by severe IM.
Full Text
http://link.springer.com/article/10.1007%2Fs00464-014-3693-5
DOI
10.1007/s00464-014-3693-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Park, Jae Jun(박재준)
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Yun, Gak Won(윤각원)
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139289
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