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

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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.

Original languageEnglish
Pages (from-to)849-856
Number of pages8
JournalGastrointestinal Endoscopy
Volume86
Issue number5
DOIs
Publication statusPublished - 2017 Nov

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All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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