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Noh, Park, Yun, Kwon, Yoon, Chang, Oh, Joo, Lee, Kim, Yeon, Kim, Byun, and Bak: Clinicopathologic Characteristics of Patients Who Underwent Curative Additional Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer or Adenoma
Original Article

Korean J Gastroenterol 2012;59(4):289-295.

Published online: 4 October 2012

DOI: https://doi.org/10.4166/kjg.2012.59.4.289

Clinicopathologic Characteristics of Patients Who Underwent Curative Additional Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer or Adenoma

Hyejin Noh, Jong-Jae Park, Jae-Won Yun, Minjung Kwon, Dae Woong Yoon, Won Jin Chang, Ha Yong Oh, Moon Kyung Joo, Beom Jae Lee, Ji Hoon Kim, Jong Eun Yeon, Jae Seon Kim, Kwan Soo Byun, Young-Tae Bak

Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

Correspondence to: Jong-Jae Park, Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3003, Fax: +82-2-2626-1038, E-mail: gi7pjj@yahoo.co.kr

Received 9 September 2011       Revised 17 October 2011       Accepted 18 October 2011

Copyright © 2012 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

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.

Keywords: Endoscopic submucosal dissection, Gastrectomy, Early gastric cancer, Gastric adenoma

References

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Fig. 1.
Baseline pathologic findings before ESD. ESD, endoscopic submucosal dissection; EGC, early gastric cancer; WD, well differentiated adeno-carcinoma; MD, moderately differentiated adenocarcinoma; PD, poorly differentiated adnocarcinoma; SRC, signet ring cell carcinoma; Un, un-known; LGD, low grade dysplasia; HGD, high grade dysplasia.
kjg-59-289f1.tif
Fig. 2.
The reasons for additional gastrectomy in 32 patients.
kjg-59-289f2.tif
Table 1.
Risk Factors of Additional Gastrectomy after ESD
  Additional gastrectomy (N=32) p-value
ESD indication   <0.001
 Conventional indication (1,011) 2/1,011 (0.2)  
 Extended indication (501) 30/501 (6.0)  
Tumor location   0.351
 Body, GC (244) 14/244 (5.7)  
 Body, LC (175) 7/175 (4.0)  
 Antrum (738) 6/738 (0.8)  
 Angle (199) 4/199 (2.0)  
 Fundus (156) 1/156 (0.6)  
Tumor size   <0.001
 ≤2 cm (1,146) 10/1,146 (0.9)  
 ＞2 cm (366) 22/366 (6.0)  
Results of ESD   <0.001
 En bloc resection (1,330) 20/1,330 (1.5)  
 Piecemeal resection (182) 12/182 (6.6)  

Values are presented as n (%).

ESD, endoscopic submucosal dissection; GC, greater curvature; LC lesser curvature.

Table 2.
Baseline Characteristics of Patients Who Had Additional Gastrectomy according to Indications of Operation
Operation indication Complication (n=13) Margin involvement (n=13) Lymphatic invasion (n=6) p-value
Age (yr) 55.4±9.7 61.9±11.3 57.2±7.0 0.541
Sex (male/female) 11/2 8/5 3/3 0.349
Tumor location        
 Body, GC 7 (53.8) 3 (23.1) 4 (66.7)  
 Body, LC 4 (30.8) 2 (13.4) 1 (16.7) 0.071
 Antrum 2 (15.4) 4 (30.8) 0 (0)  
 Angle 0 (0) 4 (30.8) 0 (0)  
 Fundus 0 (0) 0 (0) 1 (16.7)  
Tumor size        
 ≤2 cm 3 (23.1) 4 (30.8) 3 (50.0)  
 ＞2 cm 10 (76.9) 9 (69.2) 3 (50.0) 0.539

Values are presented as mean±SD or n (%).

GC, greater curvature; LC, lesser curvature.

Table 3.
Post Operation Pathological Findings of 32 Patients Who Had Additional Gastrectomy
Variables (n) Residual tumor LN involvements
Bleeding (9) 8/9 (88.9) 3/9 (33.3)
Perforation (4) 3/4 (75.0) 0/4 (0)
Margin involvement (13)    
 Lateral margin (4) 3/4 (75.0) 1/4 (25.0)
 Deep margin (5) 3/5 (60.0) 0/5 (0)
 Both margin (4) 3/4 (75.0) 0/4 (0)
Lymphatic invasion (6) 0/6 (0) 3/6 (50.0)

Values are presented as n (%).

LN, lymph node.

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