Prognosis of Patients with Early Gastric Cancer Who Underwent Additional Gastrectomy After Incomplete Endoscopic Mucosal Resection

Abstract

Background: In case that the early gastric cancer is not completely excised by EMR, additional gastrectomy with lymph node dissection is standard therapy. The adverse outcome of gastrectomy after incomplete EMR is one of our concerns due to the potential spread of malignant cell during procedure. Methods: We analyzed 56 consecutive patients with EGC who were treated surgically after incomplete EMR or gastric wall perforation between January 1997 and December 2005. EMR was considered incomplete when there were positive lateral margin, positive vertical margin including submucosal invasion, lymphovascular involvement or when histologic type was undifferentiated. Results: Fifty three patients were followed up for a median of 47 (range 12-115) months. Mean tumor size was 21.2 (range 8-51)mm. Reasons for subsequent gastrectomy were as follows: 30 cases of positive lateral margin; 24 cases of positive vertical margin; 8 cases of lymphovascular involvement; 12 cases of undifferentiated histologic type; 2 cases of gastric wall perforation. 21 patients had 2 reasons; 1 patient had 3 reasons. Curative resection with LN dissection was performed in 51 patients, and 2 patients underwent wedge resection. 28 patients (53%) had microscopic evidence of residual cancer in the stomach. The mean number of dissected LN was 17 (range 2-38). LN metastasis was found in 3 patients (5.8%) whose reason for surgery was submucosal invasion in 2 cases, and submucosal invasion and lymphovascular involvement in another case. There was one case of recurrence after gastrectomy (1.9%). Recurrence occurred as hematogenous metastasis 70 months after surgery, and he died 21 months after recurrence.Conclusion.This study suggests that the outcome of additional gastrectomy following incomplete EMR may be similar to that of primary gastrectomy for EGC.