title: Additional gastrectomy after endoscopic mucosal resection for early gastric cancer.
abstract: The aim of this study was to examine the clinicopathological characteristics of cases undergoing additional gastrectomy after endoscopic mucosal resection (EMR) for early gastric cancer (EGC) and the appropriate strategy for treating those after incomplete EMR. We studied 16 patients who underwent additional gastrectomy after EMR for EGC. The reasons for additional gastrectomy were positive horizontal margin (8 cases), indeterminate horizontal margin (2 cases), positive vertical margin (4 cases), submucosal invasion (7 cases), lymphatic invasion (4 cases), venous invasion (1 case), and local recurrence (2 cases, including overlapped cases). Residual cancer was found in 6 of the 13 cases (46%), while no lymph node metastasis was found in any case; there were cases in which local resection was possible depending on tumor location and cases in which additional gastrectomy was performed due to suspected residual cancer but the specimens were free of cancer; follow-up without intervention appears to be feasible in some of these cases. When performing additional gastrectomy after EMR, the most appropriate method should be chosen so as not to worsen the quality of life of the patient while taking radical cure into consideration.
authors.affiliation: 1 Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center Hospital, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yajima
authors.forename: Noburo
authors.initials: N
authors.lastname: Omura
authors.forename: Naoto
authors.initials: N
authors.lastname: Takahashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshida
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D012086:Reoperation; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic mucosal resection; Gastric cancer; Lymph node metastasis; Residual cancer; Surgical treatment