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Bae, Kim, Kim, and Song: Clinicopathological Characteristics of Patients Who Received Additional Gastrectomy after Endoscopic Resection due to Gastric Cancer
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 78(2): 87-92.

Published online: 19 February 2010

DOI: https://doi.org/10.4174/jkss.2010.78.2.87

Clinicopathological Characteristics of Patients Who Received Additional Gastrectomy after Endoscopic Resection due to Gastric Cancer

Jung Min Bae, M.D., Se Won Kim, M.D., Sang Woon Kim, M.D., Sun Kyo Song, M.D.

Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea.

Corresponding author (swkim@med.yu.ac.kr)

Received 26 September 2009       Accepted 1 December 2009

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Recently, early gastric cancer has increased in Korea. Thus, endoscopic resection and laparoscopic gastrectomy has increased in early gastric cancer patients. But, endoscopic resection of early gastric cancer has many problems such as poor long-term survival data, diverse endoscopic techniques, ambiguous follow-up strategy, nonuniform pathologic interpretation and so on. We studied patients that received additional gastrectomy after EMR/ESD. We analyzed clinicopathological characteristics states before and after EMR/ESD.

Methods

From 1998 to 2008, 56 patients received additional gastrectomy after EMR/ESD due to gastric cancer. We analyzed tumor characteristics, endoscopic resection type, reasons for gastrectomy, post-operative characteristics, etc., retrospectively from medical records.

Results

The ratio of male to female was 2:1. Six patient tumors were larger than 2 cm in size. Forty-five patients received EMR and 12 patients received ESD. Common macroscopic feature of endoscopic findings were superficial elevated and superficial depressed between 10 mm and 20 mm. Forty patients received immediate gastrectomy due to incomplete endoscopic resection. Sixteen patients received additional gastrectomy during follow-up period after EMR/ESD. The most common reason of immediate gastrectomy was positive resection margin. The most common reason of follow-up gastrectomy was cancer recurrence. Three patients had advanced gastric cancer in follow up gastrectomy group. Two patients died due to gastric cancer in immediate gastrectomy group and follow-up gastrectomy group.

Conclusion

Active effort for surgical treatment is needed when the gastric cancer characteristics of patients is inadequate for endoscopic resection. Uniform pathologic interpretation is essential for confirming completeness of endoscopic resection. Treatment and follow-up strategy after endoscopic resection is important due to recurrence and new cancer occurrence. Long-term and prospective randomized study should be performed to confirm safety and difficulty of endoscopic resection.

Keywords: Gastric cancer, Endoscopic resection, Gastrectomy

Figures and Tables

Table 1
Clinicopathological characteristics before gastrectomy patients characteristics
jkss-78-87-i001

*EMR = endoscopic mucosal resection; †ESD = endoscopic submucosal dissection.

Table 2
Case distribution according to tumor size and macroscopic feature
jkss-78-87-i002
Table 3
The reason for additional gastrectomy with lymph node dissection
jkss-78-87-i003

*EMR = endoscopic mucosal resection; †ESD = endoscopic submucosal dissection.

Table 4
Post-operative clinicopathologic characteristics
jkss-78-87-i004

*STG = subtotal gastrectomy; †LADG = laparoscopic assisted distal gastrectomy; ‡TG = total gastrectomy; §M = mucosa; ∥SM = submucosal; MP = muscularis propria; **SS = subserosa.

Table 5
Details of sixteen patients performed gastrectomy during follow-up period
jkss-78-87-i005

*EMR = endoscopic mucosal resection; †ESD = endoscopic submucosal dissection; ‡M = mucosa; §Confirm margin (-) after repeated endoscopic resection; ∥SM = submucosal.

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