Surgical Treatment for Patients Who Underwent Endoscopic Mucosal Resection (EMR)/Endoscopic Submucosal Dissection (ESD) of Early Gastric Cancer (EGC)
김민규, 김범수, 김태환, Kim Kap-Choong, 육정환, 오성태, 김병식,
소속 상세정보
김민규 ( Kim Min-Gyu )
University of Ulsan College of Medicine Department of Gastric Surgery
김범수 ( Kim Beom-Su )
University of Ulsan College of Medicine Department of Gastric Surgery
김태환 ( Kim Tae-Hwan )
University of Ulsan College of Medicine Department of Gastric Surgery
( Kim Kap-Choong )
University of Ulsan College of Medicine Department of Gastric Surgery
육정환 ( Yook Jeong-Hwan )
University of Ulsan College of Medicine Department of Gastric Surgery
오성태 ( Oh Sung-Tae )
University of Ulsan College of Medicine Department of Gastric Surgery
김병식 ( Kim Byung-Sik )
University of Ulsan College of Medicine Department of Gastric Surgery
KMID : 0371320110800030165
Abstract
Purpose: To evaluate the necessity for additional surgical treatment after Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), we analyzed the pathologic results of patients who underwent surgical treatment.
Methods: 140 consecutive patients underwent additional surgical treatment after EMR/ESD with en bloc resection between April 2005 and November 2009 at ASAN Medical Center. Additional surgical treatments were undergone for following conditions such as incomplete dissection (involvement of margin), undifferentiated-type histology (≥2 cm) and submucosal cancer.
Results: One patient with deep margin involvement displayed advanced gastric cancer after gastrectomy. Three of 74 patients with clear resection margin were confirmed to have residual cancer at ESD site and 2 of 3 patients displayed advanced gastric cancer after surgery. In univariate analysis for metastasis of lymph node, deep submucosal invasion (over sm2 or 500μm) and the presence of lymphovascular invasion showed significant differences for lymph node metastasis. Especially, lymphovascular invasion was an important predictive factor for lymph node metastasis in multivariate analysis. In analysis for residual cancer, lateral margin involvement and large tumor (>3 cm) were risk factors. And, only lateral margin involvement showed significant risk in multivariate analysis.
Conclusion: Although EMR/ESD were fully accomplished for resection margin, gastrectomy and lymph node dissection were positively necessary for patients with deepsubmucosal invasion (over sm2 or 500μm) and the presence of lymphovascular invasion to eliminate the possibility of residual cancer or more advanced gastric cancer or metastatic lymph nodes.
키워드
Endoscopic mucosal resection (EMR); Endoscopic submucosal dissection (ESD); Early gastric cancer (EGC)
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