Role of endoscopic clipping for determining the resection line for tumors located in the middle or upper corpus of the stomach: experience with 100 gastrectomies for early gastric cancer.
BACKGROUND
The efficacy and limitations of preoperative endoscopic clipping for determining the resection line in patients with early gastric cancer remain unclear.


METHODS
Subjects comprised 100 patients with early gastric cancer (33 females, 67 males; mean age, 60.5 years; range, 33-84 years) who underwent pre-operative endoscopic clipping for lesions located in the middle or upper corpus of the stomach. The results of endoscopic clipping for a selection of appropriate surgical procedures were investigated.


RESULTS
Distal gastrectomy was performed in 94 patients, the mean length between the lesion and proximal surgical margin of the resected stomach being 28.9 +/- 18.0 mm (mean +/- SD). The surgical margin was eventually free of tumor in all patients. In 5 patients, clips were considered to be placed inadequately, and all 5 tumors were macroscopically depressed or flat and > 40 mm in size.


CONCLUSIONS
Pre-operative endoscopic clipping represents a safe and reliable procedure to determine the resection line for tumors located in the middle or upper corpus of the stomach for treatment of early gastric cancer. During surgical resection, frozen section examination of the proximal cut end is recommended for patients with tumors that are macroscopically depressed or flat and > 40 mm in size, or that display a macroscopically unclear proximal margin.
Kikuchi
Shiro
S
Department of Surgery, School of Medicine, Kitasato University, 1-15-1, Kitasato, Sagamihara-shi, 228-8555 Kanagawa, Japan. kiku@kitasato-u.ac.jp
Hirai
Kazuya
K
Kuroyama
Shinichi
S
Katada
Natsuya
N
Sakuramoto
Shinichi
S
Kobayashi
Nobuyuki
N
Shimao
Hitoshi
H
Watanabe
Masahiko
M
Mitomi
Hiroyuki
H
Mikami
Tetsuo
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*