Clinical outcome of endoscopic mucosal resection for treating early gastric cancer

Lee, Joon Wook; Lee, In Seok; Paik, Chang Nyol; Park, Jae Myung; Oh, Jung Hwan; Cho, Yu Kyung; Kim, Sang Woo; Choi, Myung Gyu; Chung, In Sik

Abstract

BACKGROUND: Endoscopic mucosal resection (EMR) has been widely accepted as a curative treatment for those cases of early gastric cancer (EGC) that have a low probability of lymph node metastasis. The aim of this study was to evaluate the clinical outcome of EMR for the treatment of EGC.
METHODS
We retrospectively analyzed the medical records of 50 patients who were finally confirmed to have EGC among the 214 patients who were treated with EMR at Kangnam St. Mary's Hospital from January 1999 through December 2004. The mean age of patients was 67.1 years (range: 47~83), and the male to female ratio was 7:3 (35/15). The mean follow-up period was 20.5 months (range: 1~72).
RESULTS
The mean size of the lesions was 16.6+/-7.4 mm. Forty-two cases (84%) were located in the lower third of the stomach. There were 28 cases (56%) of endoscopically detected elevated lesions (type I, IIa). Complete resection was achieved in 40 cases (80%). The complete resection rate was higher when the lesions had a diameter not exceeding 30 mm, when they were located in the lower third of the stomach and when they were the elevated macroscopic type. The en bloc resection rate was the highest for endoscopic submucosal dissection. Of the 40 cases with complete resection, 6 cases (15%) developed local recurrence after a mean follow-up period of 12.3 months (range: 2~22). Of these 6 cases, 4 cases developed at previous EMR sites and 2 cases developed at other sites.
CONCLUSIONS
EMR is an effective method as a curative treatment for EGC with a high complete resection rate, but some cases that are completely resected by EMR will experience recurrence. It is necessary to perform follow up at established intervals for a long time after EMR.