Additive endoscopic resection may be sufficient for patients with a positive lateral margin after endoscopic resection of early gastric cancer

作者：Kim Hae Won; Kim Jie Hyun^*; Park Jun Chul^*; Jeon Mi Young; Lee Yong Chan; Lee Sang Kil; Shin Sung Kwan; Chung Hyun Soo; Noh Sung Hoon; Kim Jong Won; Choi Seung Ho; Park Jae Jun; Youn Young Hoon; Park Hyojin

来源：Gastrointestinal Endoscopy, 2017, 86(5): 849-856.

DOI：10.1016/j.gie.2017.02.037

Background and Aims: No well-established treatment strategies exist for lateral margin positivity (LM+) alone after endoscopic resection (ER) of early gastric cancer (EGC). Thus, we aimed to clarify a treatment strategy for non-curative resection (non-CR) with LM+ alone after ER in EGC.
Methods: Among 2065 patients with EGC treated by ER, 76 (3.6%) with only LM+ after non-CR of EGC were reviewed retrospectively. Of these, 28 underwent gastrectomy, 25 underwent argon plasma coagulation (APC), and 23 underwent repeat ER (re-ER). We analyzed the clinicopathologic characteristics of all patients and compared those who underwent additive surgery, APC, or re-ER.
Results: Of the 76 patients, 28 (36.8%) fulfilled the absolute criteria and 48 (63.2%) the expanded criteria for ER. Among the latter patients, the proportion undergoing additive surgery was 75.0%, higher than that of patients in the former group (P = .014). Residual cancer cells were observed in 70.6% of patients after additive surgery or reER. Residual cancer cells were observed significantly more often in patients with undifferentiated-type than in those with differentiated-type EGC (P = .02). However, no lymph node metastasis was observed in any patient after additive surgery.
Conclusions: Our results suggest that endoscopic treatment may be a sufficient additive therapy for patients with LM+ alone after ER, irrespective of whether the absolute or expanded ER criteria are used. However, as complete ablation of remnant cells cannot be guaranteed, re-ER is a better additive treatment than APC.

• 出版日期2017-11