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Additive endoscopic resection may be sufficient for patients with a positive lateral margin after endoscopic resection of early gastric cancer

 Hae Won Kim  ;  Jie-Hyun Kim  ;  Jun Chul Park  ;  Mi Young Jeon  ;  Yong Chan Lee  ;  Sang Kil Lee  ;  Sung Kwan Shin  ;  Hyun Soo Chung  ;  Sung Hoon Noh  ;  Jong Won Kim  ;  Seung Ho Choi  ;  Jae Jun Park  ;  Young Hoon Youn  ;  Hyojin Park 
 GASTROINTESTINAL ENDOSCOPY, Vol.86(5) : 849-856, 2017 
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BACKGROUND AND AIMS: No well-established treatment strategies exist for lateral margin positivity (LM+) alone after endoscopic resection (ER) of early gastric cancer (EGC). Thus, we aimed to clarify a treatment strategy for non-curative resection (non-CR) with LM+ alone after ER in EGC. METHODS: Among 2065 patients with EGC treated by ER, 76 (3.6%) with only LM+ after non-CR of EGC were reviewed retrospectively. Of these, 28 underwent gastrectomy, 25 underwent argon plasma coagulation (APC), and 23 underwent repeat ER (re-ER). We analyzed the clinicopathologic characteristics of all patients and compared those who underwent additive surgery, APC, or re-ER. RESULTS: Of the 76 patients, 28 (36.8%) fulfilled the absolute criteria and 48 (63.2%) the expanded criteria for ER. Among the latter patients, the proportion undergoing additive surgery was 75.0%, higher than that of patients in the former group (P = .014). Residual cancer cells were observed in 70.6% of patients after additive surgery or re-ER. Residual cancer cells were observed significantly more often in patients with undifferentiated-type than in those with differentiated-type EGC (P = .02). However, no lymph node metastasis was observed in any patient after additive surgery. CONCLUSIONS: Our results suggest that endoscopic treatment may be a sufficient additive therapy for patients with LM+ alone after ER, irrespective of whether the absolute or expanded ER criteria are used. However, as complete ablation of remnant cells cannot be guaranteed, re-ER is a better additive treatment than APC.
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김종원(Kim, Jong Won) ; 김지현(Kim, Ji Hyun) ; 노성훈(Noh, Sung Hoon) ; 박재준(Park, Jae Jun) ; 박준철(Park, Jun Chul) ; 박효진(Park, Hyo Jin) ; 신성관(Shin, Sung Kwan) ; 윤영훈(Youn, Young Hoon) ; 이상길(Lee, Sang Kil) ; 이용찬(Lee, Yong Chan) ; 전미영(Jeon, Mi Young) ; 정현수(Chung, Hyun Soo) ; 최승호(Choi, Seung Ho)
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