Korean J Gastroenterol.  2012 Apr;59(4):289-295. 10.4166/kjg.2012.59.4.289.

Clinicopathologic Characteristics of Patients Who Underwent Curative Additional Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer or Adenoma

• Noh H
• Park JJ
• Yun JW
• Kwon M
• Yoon DW
• Chang WJ
• Oh HY
• Joo MK
• Lee BJ
• Kim JH
• Yeon JE
• Kim JS
• Byun KS
• Bak YT

• KMID: 1364832
• DOI: http://doi.org/10.4166/kjg.2012.59.4.289

Abstract

BACKGROUND/AIMS
Endoscopic submucosal dissection (ESD) has been widely performed. However, procedure related-complications and the risk of tumor recurrence are limitations. We analyzed the clinicopathological characteristics of patients who underwent curative additional gastrectomy (gastrectomy) after ESD.
METHODS
The clinical characteristics of cases underwent gastrectomy after ESD were retrospectively analyzed.
RESULTS
Between January 2002 and August 2010, 1,512 cases underwent ESD for early gastric cancer (n=511) or adenoma (n=1,001). Thirty-two cases (2.1%) underwent gastrectomy after ESD. Thirty cases (2.0%) were EGC and 2 cases (0.1%) were adenoma. Extended indication, larger tumor size and piecemeal resection were risk factors for gastrectomy after ESD. According to the causes of gastrectomy, 13 cases underwent gastrectomy due to complications (40.6%; bleeding in 9, perforation in 4), and 19 cases based on pathological results (incomplete resection in 13, lymphatic invasion in 6). In cases with incomplete resection, the rate of residual tumor and lymph node metastasis after gastrectomy was 69.2% (75% lateral margin, 60% deep and 75% both) and 7.7%, respectively. Three (50%) of the 6 cases with lymphatic invasion had lymph node metatstasis.
CONCLUSIONS
The causes of gastrectomy after ESD were the procedure-related complications, the incomplete resection and lymphatic invasion. For complete and curative ESD, endoscopists should try to minimize complications and determine the depth of invasion accurately before ESD.

Keyword

Endoscopic submucosal dissection; Gastrectomy; Early gastric cancer; Gastric adenoma

MeSH Terms

Adenoma/*pathology/surgery
Aged
Female
Gastrectomy
Gastric Mucosa/pathology/surgery
Gastroscopy
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Neoplasm, Residual
Retrospective Studies
Risk Factors
Stomach Neoplasms/*pathology/surgery

Figure

• 

  Fig. 1. Baseline pathologic findings before ESD. ESD, endoscopic submucosal dissection; EGC, early gastric cancer; WD, well differentiated adeno-carcinoma; MD, moderately differentiated adenocarcinoma; PD, poorly differentiated adnocarcinoma; SRC, signet ring cell carcinoma; Un, un-known; LGD, low grade dysplasia; HGD, high grade dysplasia.

• 

  Fig. 2. The reasons for additional gastrectomy in 32 patients.

Reference

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