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Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? a large‐scale Korean multi‐center study
Author(s) -
Song Kyo Young,
Hyung Woo Jin,
Kim Hyung Ho,
Han Sang Uk,
Cho Gyu Seok,
Ryu Seung Wan,
Lee Hyuk Joon,
Kim Min Chan
Publication year - 2008
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21074
Subject(s) - medicine , gastrectomy , cancer , general surgery , residual , center (category theory) , resection , surgery , gastroenterology , computer science , chemistry , algorithm , crystallography
Background and Objectives To clarify optimal treatment guidelines for residual or local recurrence after endoscopic resection (ER). Methods Eighty‐six patients underwent gastrectomy due to incomplete ER and local recurrence after ER. The pathological findings of ER and gastrectomy specimens were analyzed. Results The cause of gastrectomy was categorized into five groups; submucosal (sm) invasion without margin involvement, positive margin, margin not evaluable, high risk of lymph node metastasis and local recurrence after ER. According to the pathological findings of gastrectomy specimens, remnant cancer and lymph node metastases were found in 56 (65.1%) and in 5 patients (5.8%), respectively. At 10 gastrectomy specimens which were sm invasion without margin involvement, the scattered residual cancer cells were found around the ulcer scar in 2 (20%) patients. In 11 of 44 margin involvement specimens, no residual cancer or lymph node metastasis was found. In patients with local recurrence, mean duration from ER to surgery was 14.8 months, and 19% of patients were found to have sm or deeper depth of invasion. Conclusion Gastrectomy with lymph node dissection should be performed in patients with sm invasion with or without margin involvement. However, minimal approach other than gastrectomy could further be applied to selected patients. J. Surg. Oncol. 2008;98:6–10. © 2008 Wiley‐Liss, Inc.