title: The role of surgery after incomplete endoscopic mucosal resection for early gastric cancer.
abstract: OBJECTIVE
  Endoscopic mucosal resection (EMR) is a relatively new treatment option for early gastric cancer (EGC). However, cases of incomplete EMR resulting in a positive lateral margin or submucosal invasion (positive vertical margin) have been reported. We conducted this study to evaluate the role of surgery after incomplete EMR for EGC.
  
  
  METHODS
  We analyzed 19 patients who underwent gastrectomy as a result of an incomplete EMR. The patients were divided into three groups according to the type of incomplete EMR: a positive lateral margin (LM) group (n = 9), a positive vertical margin (VM) group (n = 4), and a positive lateral and vertical margin (LM + VM) group (n = 6).
  
  
  RESULTS
  The positive residual tumor rate and the positive lymph node rate were 44.4% (4/9) and 0% (0/9) in the LM group, 50.0% (2/4) and 25.0% (1/4) in the VM group, and 83.3% (5/6) and 16.7% (1/6), LM + VM group, respectively. Curative resection was performed in all patients and there was no recurrence in 30.8 months of follow-up.
  
  
  CONCLUSIONS
  Radical surgery is recommended for patients with a positive lateral resection margin or submucosal invasion, or both, after EMR for EGC, because of the possibility of residual tumor or lymph node metastasis.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 100-744, South Korea.
authors.forename: Yoo Seung
authors.initials: YS
authors.lastname: Chung
authors.forename: Do-Joong
authors.initials: DJ
authors.lastname: Park
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Lee
authors.forename: Sang-Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Hyun-Chae
authors.initials: HC
authors.lastname: Jung
authors.forename: In-Sung
authors.initials: IS
authors.lastname: Song
authors.forename: Woo-Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Kuhn-Uk
authors.initials: KU
authors.lastname: Lee
authors.forename: Kuk-Jin
authors.initials: KJ
authors.lastname: Choe
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012086:Reoperation; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome