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

Abstract：

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.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Kim HW,Kim JH,Park JC,Jeon MY,Lee YC,Lee SK,Shin SK,Chung HS,Noh SH,Kim JW,Choi SH,Park JJ,Youn YH,Park H

doi

10.1016/j.gie.2017.02.037

subject

Has Abstract

pub_date

2017-11-01 00:00:00

pages

849-856

issue

5

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(17)30183-9

journal_volume

86

pub_type

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