Clinicopathologic Features and Treatment of Residual Early Cancers After Endoscopic Mucosal Resection of the Stomach

Abstract

We sometimes encounter residual or recurrent cancers after endoscopic mucosal resection (EMR) for early gastric cancer. The aim of the present study was to clarify the clinicopathologic characteristics of and optimal treatment for the residual cancers after EMR. Seventy-four patients with early gastric cancer were treated with EMR between 1994 and 2004. These patients were divided into 2 groups as follows: the curative group (n=59) and the noncurative group (n=15). The clinicopathologic data were compared between the 2 groups and the outcomes of additional therapy were reviewed. In the noncurative group, the tumors were located significantly frequently on the upper or middle third of the stomach compared with the curative group (P<0.05). The number of fragments in EMR was significantly larger in the noncurative group than in the curative group (P<0.05). Fifteen patients required additional treatment because of the residual cancer. Nine (75%) of 12 patients requiring surgery underwent laparoscopic surgery. Three patients were treated by endoscopic therapy. EMR with a single fragment and with a sufficient margin is useful for the complete resection of early gastric cancer. When residual cancer occurs, laparoscopic gastrectomy may be a good alternative.