Abstract
Purpose: Recently, early gastric cancer has increased in Korea. Thus, endoscopic resection and laparoscopic gastrectomy has increased in early gastric cancer patients. But, endoscopic resection of early gastric cancer has many problems such as poor long-term survival data, diverse endoscopic techniques, ambiguous follow-up strategy, nonuniform pathologic interpretation and so on. We studied patients that received additional gastrectomy after EMR/ESD. We analyzed clinicopathological characteristics states before and after EMR/ESD. Methods: From 1998 to 2008, 56 patients received additional gastrectomy after EMR/ESD due to gastric cancer. We analyzed tumor characteristics, endoscopic resection type, reasons for gastrectomy, post-operative characteristics, etc., retrospectively from medical records. Results: The ratio of male to female was 2：1. Six patient tumors were larger than 2 ㎝ in size. Forty-five patients received EMR and 12 patients received ESD. Common macroscopic feature of endoscopic findings were superficial elevated and superficial depressed between 10 ㎜ and 20 ㎜. Forty patients received immediate gastrectomy due to incomplete endoscopic resection. Sixteen patients received additional gastrectomy during follow-up period after EMR/ESD. The most common reason of immediate gastrectomy was positive resection margin. The most common reason of follow-up gastrectomy was cancer recurrence. Three patients had advanced gastric cancer in follow up gastrectomy group. Two patients died due to gastric cancer in immediate gastrectomy group and followup gastrectomy group. Conclusion: Active effort for surgical treatment is needed when the gastric cancer characteristics of patients is inadequate for endoscopic resection. Uniform pathologic interpretation is essential for confirming completeness of endoscopic resection. Treatment and follow-up strategy after endoscopic resection is important due to recurrence and new cancer occurrence. Long-term and prospective randomized study should be performed to confirm safety and difficulty of endoscopic resection.
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