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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2007

01-12-2007 | Original Paper

Surgical Indication for Non-curative Endoscopic Resection in Early Gastric Cancer

Authors: Keun Won Ryu, MD, Il Ju Choi, MD, Young Woo Doh, MD, Myeong-Cherl Kook, MD, Chan Gyoo Kim, MD, Hyun-Jung Park, RN, Jun Ho Lee, MD, Jong-Seok Lee, MD, Jong Yeul Lee, MD, Young Woo Kim, MD, Jae-Moon Bae, MD

Published in: Annals of Surgical Oncology | Issue 12/2007

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Abstract

Background

Endoscopic resection (ER) is an effective treatment for early gastric cancer (EGC) without lymph node metastasis. However, after ER additional surgery may be needed to manage the risks presented by residual cancer or lymph node metastasis.

Methods

ER was performed on 344 gastric adenocarcinomas between November 2001 and April 2006 at the Korean National Cancer Center under the strict pre-procedural indication. The authors performed operations in 43 patients due to: residual mucosal cancer, a mucosal cancer larger than 3 cm, or a submucosal cancer regardless of size or margin involvement. ER and surgical specimens were reviewed and analyzed for residual cancer and lymph node metastasis.

Results

Based on examinations of ER specimens, cancer was confined to the mucosal layer in 15 patients (34.9%) and invaded the submucosal layer in 28 patients (65.1%). Surgical specimens showed residual cancer in 17 patients (39.5%) and lymph node metastasis in four (9.3%). Neither residual cancer nor lymph node metastasis was found in patients with less than 500 μm submucosal invasion without margin involvement in ER specimens. In three of four patients with lymph node metastasis, the depth of submucosal invasion was 500 μm or more; the remaining patient had a 4-cm-sized differentiated mucosal cancer.

Conclusions

When a pathologic evaluation of an ER specimen reveals more than 500 μm of submucosal invasion or a mucosal cancer of larger than 3 cm, surgery should be considered due to the risk of lymph node metastasis.
Literature
1.
Parkin DM, Bray F, Ferlay J, Pisani P. Golbal cancer statistics, 2002. CA Cancer J Clin 2005;55:74–108PubMedCrossRef
2.
Shin HR, Won YJ, Jung KW, et al. Nationwide cancer incidence in Korea, 1999–2001; First result using the national cancer incidence database. Cancer Res Treat 2005;37:325–31CrossRefPubMed
3.
4.
Choi IJ, Kim CG, Chang HJ, Kim SG, Kook MC, Bae JM. The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm. Gastrointest Endosc 2005;62:860–5PubMedCrossRef
5.
Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early gastric cancer of the upper gastrointestinal tract. J Clin Oncol 2005;23:4490–8PubMedCrossRef
6.
Ono H, Kondo H, Gotada T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001;48:225–9PubMedCrossRef
7.
8.
Onozato Y, Ishihara H, Iizuka H, et al. Endoscopic submucosal dissection for early gastric cancers and large flat adenomas. Endoscopy 2006;38:980–6PubMedCrossRef
9.
Oka S, Tanaka S, Kaneko I, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006;64:877–83PubMedCrossRef
10.
Yokoi C, Gotoda T, Hamanaka H, Oda I. Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 2006;64:212–8PubMedCrossRef
11.
Oka S, Tanaka S, Kaneko I, et al. Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection. Endoscopy 2006;38:996–1000PubMedCrossRef
12.
Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer. Gastric Cancer 2000;3:219–25PubMedCrossRef
13.
Seto Y, Shimoyana S, Kitayama J, et al. Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer. Gastric Cancer 2001;4:34–8PubMedCrossRef
14.
Hizawa K, Iwai K, Esaki M, Matsumoto T, Suekane H, Iida M. Is endoscopic ultrasonography indispensable in assessing the appropriateness of endoscopic resection for gastric cancer? Endoscopy 2002;34:973–8PubMedCrossRef
15.
Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroentrol 2006;41:929–42CrossRef
16.
Nagano H, Ohyama S, Fukunaga T, et al. Indication for gastrectomy after incomple EMR for early gastric cancer. Gastric Cancer 2005;8:149–54PubMedCrossRef
17.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 2nd English edition. Gastric Cancer 1998;1:10–24PubMedCrossRef
18.
Kunisaki C, Akiyama H, Nomura M, et al. Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol 2006;13:363–9PubMedCrossRef
19.
Korenaga D, Orita H, Maekawa S, et al. Pathological appearance of the stomach after endoscopic mucosal resection for early gastric cancer. Br J Surg 1997;84:1563–6PubMedCrossRef
20.
Yano H, Kimura Y, Iwazawa T, Monden T. Laparoscopic management for local recurrence of early gastric cancer after endoscopic mucosal resection. Surg Endosc 2005;19:981–5PubMedCrossRef
21.
Kitamura T, Tanabe S, Koizumi W, Mitomi H, Saigenji K. Argon plasma coagulation for early gastric cancer: technique and outcome. Gastrointest Endosc 2006;63:48–54PubMedCrossRef
22.
Nakajima T, Ohta K, Ohyama K. Tabular analysis of CIH (Cancer Institute Hospital) database. In: Nakajima T, Yamaguchi T (eds.) Multimodality therapy for gastric cancer. New York Heidelberg Berlin Tokyo: Springer Verlag, 1999:197–267
23.
Ono H. Early gastric cancer: diagnosis, pathology, treatment techniques and treatment outcomes. Eur J Gastroenterol Hepatol 2006;18:863–6PubMedCrossRef
24.
25.
Namieno T, Koito K, Higashi T, et al. Assessing the suitability of gastric carcinoma for limited resection: histologic differentiation of endoscopic biopsy. World J Surg 1998;22:865–8PubMedCrossRef
26.
Abe N, Watanabe T, Suzuki K, et al. Risk factors predictive of lymph node metastasis in depressed early gastric cancer. Am J Surg 2002;183:68–172CrossRef
27.
Gotoda T, Sasako M, Ono H, Katai H, Sano T, Shimoda T. Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer. Br J Surg 2001;88:444–9PubMedCrossRef
28.
Abe N, Watanabe T, Sugiyama M, et al. Endoscopic treatment or surgery for undifferentiated early gastric cancer? Am J Surg 2004;188:181–4PubMedCrossRef
29.
Yanai H, Noguchi T, Mizumachi S, et al. A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer. Gut 1999;44:361–5PubMedCrossRef
30.
Ganpathi IS, So JB, Ho KY. Endoscopic ultrasonography for gastric cancer: does it influence treatment? Surg Endosc 2006;20:559–62PubMedCrossRef
Metadata
Title
Surgical Indication for Non-curative Endoscopic Resection in Early Gastric Cancer
Authors
Keun Won Ryu, MD
Il Ju Choi, MD
Young Woo Doh, MD
Myeong-Cherl Kook, MD
Chan Gyoo Kim, MD
Hyun-Jung Park, RN
Jun Ho Lee, MD
Jong-Seok Lee, MD
Jong Yeul Lee, MD
Young Woo Kim, MD
Jae-Moon Bae, MD
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9536-z

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