title: Additional Surgery After Non-curative Resection of ESD for Early Gastric Cancer.
abstract: OBJECTIVE
  The appropriate additional surgery after non-curative resection of Endoscopic Mucosal Resection (ESD) for early gastric cancer is herein discussed.
  
  
  METHODS
  Data on 54 patients after non-curative resection of ESD were evaluated. These patients were broadly classified according to the risk of lymph node metastasis with lesions into group A (without risk) (n=26) and group B (with risk) (n=28). Their treatment results were evaluated.
  
  
  RESULTS
  The incidence of residual lesion was 7.7% in group A and 14.3% in group B. Risk factors were piecemeal resection, involvement of the horizontal margin (HM1) or unclear involvement of the horizontal margin (HMX) and with ulceration. Lymph node metastasis was detected in one patient with lymphatic invasion, total diameter of 3 cm or more and submucosal invasion over 0.5 mm (SM2). The 5-year survival rate was 93% and none of the patients died of gastric cancer.
  
  
  CONCLUSIONS
  Follow-up observation was reasonable in group A. Patients who are judged as having undergone piecemeal resection, HM1 or HMX and with ulceration, should be treated by additional surgery and patients judged with SM2 or total diameter of 3 cm or more or lymphatic invasion should be treated by additional surgery with lymphadectomy in group B.
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan katsusu@dnh.twmu.ac.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Katsube
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Murayama
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Usuda
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Shimazaki
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Asaka
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Soich
authors.initials: S
authors.lastname: Konnno
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Miyaki
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Takebumi
authors.initials: T
authors.lastname: Usui
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Hazime
authors.initials: H
authors.lastname: Yokomizo
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Schunichi
authors.initials: S
authors.lastname: Shiozawa
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshimatsu
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimakawa
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Naritaka
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ESD; Non-curative resection; early gastric cancer