title: [Clinicopathologic characteristics of patients who underwent curative additional gastrectomy after endoscopic submucosal dissection for early gastric cancer or adenoma].
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) has been widely performed. However, procedure related-complications and the risk of tumor recurrence are limitations. We analyzed the clinicopathological characteristics of patients who underwent curative additional gastrectomy (gastrectomy) after ESD.
  
  
  METHODS
  The clinical characteristics of cases underwent gastrectomy after ESD were retrospectively analyzed.
  
  
  RESULTS
  Between January 2002 and August 2010, 1,512 cases underwent ESD for early gastric cancer (n=511) or adenoma (n=1,001). Thirty-two cases (2.1%) underwent gastrectomy after ESD. Thirty cases (2.0%) were EGC and 2 cases (0.1%) were adenoma. Extended indication, larger tumor size and piecemeal resection were risk factors for gastrectomy after ESD. According to the causes of gastrectomy, 13 cases underwent gastrectomy due to complications (40.6%; bleeding in 9, perforation in 4), and 19 cases based on pathological results (incomplete resection in 13, lymphatic invasion in 6). In cases with incomplete resection, the rate of residual tumor and lymph node metastasis after gastrectomy was 69.2% (75% lateral margin, 60% deep and 75% both) and 7.7%, respectively. Three (50%) of the 6 cases with lymphatic invasion had lymph node metatstasis.
  
  
  CONCLUSIONS
  The causes of gastrectomy after ESD were the procedure-related complications, the incomplete resection and lymphatic invasion. For complete and curative ESD, endoscopists should try to minimize complications and determine the depth of invasion accurately before ESD.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Noh
authors.forename: Jong-Jae
authors.initials: JJ
authors.lastname: Park
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Yun
authors.forename: Minjung
authors.initials: M
authors.lastname: Kwon
authors.forename: Dae Woong
authors.initials: DW
authors.lastname: Yoon
authors.forename: Won Jin
authors.initials: WJ
authors.lastname: Chang
authors.forename: Ha Yong
authors.initials: HY
authors.lastname: Oh
authors.forename: Moon Kyung
authors.initials: MK
authors.lastname: Joo
authors.forename: Beom Jae
authors.initials: BJ
authors.lastname: Lee
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Jae Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Bak
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery