Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer

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• 作者：Hyuk Yoon (1)
  Sang Gyun Kim (1)
  Jeongmin Choi (1)
  Jong Pil Im (1)
  Joo Sung Kim (1)
  Woo Ho Kim (2)
  Hyun Chae Jung (1)
  
• 关键词：Early gastric cancer ; Endoscopic resection ; Residual tumor ; Recurrence ; Risk factors
• 刊名：Surgical Endoscopy
• 出版年：2013
• 出版时间：May 2013
• 年：2013
• 卷：27
• 期：5
• 页码：1561-1568
• 全文大小：283KB
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  2. Jang JS, Choi SR, Qureshi W, Kim MC, Kim SJ, Jeung JS, Han SY, Noh MH, Lee JH, Lee SW, Baek YH, Kim SH, Choi PJ (2009) Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea. Scand J Gastroenterol 44:1315-322 CrossRef
  3. Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J, Kohno S (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58:331-36 CrossRef
  4. Isomoto H, Ohnita K, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Nakao K, Kohno S, Shikuwa S (2010) Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 22:311-17 CrossRef
  5. Ryu KW, Choi IJ, Doh YW, Kook MC, Kim CG, Park HJ, Lee JH, Lee JS, Lee JY, Kim YW, Bae JM (2007) Surgical indication for non-curative endoscopic resection in early gastric cancer. Ann Surg Oncol 14:3428-434 CrossRef
  6. Jung H, Bae JM, Choi MG, Noh JH, Sohn TS, Kim S (2011) Surgical outcome after incomplete endoscopic submucosal dissection of gastric cancer. Br J Surg 98:73-8 CrossRef
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• 作者单位：Hyuk Yoon (1)
  Sang Gyun Kim (1)
  Jeongmin Choi (1)
  Jong Pil Im (1)
  Joo Sung Kim (1)
  Woo Ho Kim (2)
  Hyun Chae Jung (1)
  
  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 110-744, South Korea
  2. Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
  
• ISSN：1432-2218

文摘

Background In cases with a tumor-positive resection margin after endoscopic resection of early gastric cancer (EGC), not all patients are found to have residual or recurrent tumor. The aim of this study was to identify risk factors associated with residual/recurrent tumor in patients with incomplete endoscopic resection of EGC. Methods A retrospective analysis was performed on consecutive patients who underwent endoscopic resection of EGC at a single institution in South Korea. Patients with a tumor-positive resection margin in the specimen were divided into two groups, with and without residual/recurrent tumor, and the clinicopathologic characteristics were compared. Results A total of 102 patients with a tumor-positive lateral or vertical resection margin after endoscopic mucosal resection (n?=?10) or submucosal dissection (n?=?92) were enrolled. Overall, the rate of residual/recurrent tumor was 33.3?% (34/102): 17 residual tumors in 46 patients who immediately underwent additional endoscopic or surgical resection, and 17 recurrent tumors in 56 patients who were initially followed up with regular endoscopy during a median period of 17 (range?=?2-0) months. Univariate analysis showed that the presence of ulcer, the direction of the tumor-positive resection margin, and length of lateral resection margin involvement by the tumor were associated with the incidence of residual/recurrent tumor. In multivariate analysis, total length (cm) of lateral resection margin involvement was the only independent risk factor for residual/recurrent tumor (OR 2.05; 95?% CI 1.22-.44, p?=?0.006). Conclusions Patients with extensive tumor involvement of a lateral resection margin after endoscopic resection of EGC should consider additional endoscopic or surgical resection due to a high risk of residual/recurrent tumor.