39 Background: Endoscopic resection (ER) is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. However, surgery is sometimes needed after endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to incomplete resection. We analyzed the clinicopathological characteristics of patients who underwent additional gastrectomy after incomplete EMR/ESD. Methods: From 2003 to 2013, 80 patients received additional gastrectomy after EMR/ESD due to incomplete resection. The patients were grouped according to the presence of histologic residual tumor in specimens obtained by gastrectomy as residual tumor (RT, n = 47) or non-residual tumor (NRT, n = 33). We analyzed reasons for gastrectomy, tumor characteristics of RT and NRT group, risk factors associated with residual tumor, retrospectively from medical records. Results: After the gastrectomy, the positive residual tumor rate and lymph node metastasis rate were 58.7% (47/80) and 7.5% (6/80). RT group showed significantly higher rate of lateral and vertical margin involvement compared to NRT group (59.5 vs. 15.1%).Multivariate analysis demonstrated that endoscopic piecemeal resection, H. pylori infection, depressed or mixed type, large tumor size (> 2cm), histologic diagnosis (signet ring cell carcinoma or mixed carcinoma) were significantly independent predictive factors associated with positive residual tumor of patients who underwent additional gastrectomy after incomplete EMR/ESD (p < 0.05). Conclusions: For complete and curative ER, endoscopists should try to determine the depth of invasion, histologic diagnosis accurately and to eradicate the H. pylori infection before ER. During ER, wide marking and En bloc resection could be considered to avoid the risk of incomplete resection.
Pathological factors related to lymph node metastasis of submucosally invasive gastric cancer: criteria for additional gastrectomy after endoscopic resection
