Surgical Endoscopy

, Volume 29, Issue 2, pp 487–492 | Cite as

What are the risk factors for residual tumor cells after endoscopic complete resection in gastric epithelial neoplasia?

  • Gak Won Yun
  • Jie-Hyun KimEmail author
  • Yong Chan Lee
  • Sang Kil Lee
  • Sung Kwan Shin
  • Jun Chul Park
  • Hyun Soo Chung
  • Jae Jun Park
  • Young Hoon Youn
  • Hyojin Park



In early gastric cancer (EGC) and gastric adenoma, residual tumors may develop despite complete endoscopic resection (ER). To improve the chance of curative resection, we investigated the risk factors of residual tumor development in completely resected gastric epithelial neoplasia after ER.


In total, 3,879 gastric epithelial neoplasms showing complete resection after ER were examined; 46 (1.2 %) residual tumors were found upon follow-up endoscopy. Clinicopathological characteristics were evaluated between those with and without residual tumors.


For gastric adenoma, high-grade dysplasia and severe intestinal metaplasia (IM) in the background mucosa were significantly associated with residual tumors. For EGC, poorly differentiated adenocarcinoma (PD), signet ring cell carcinoma (SRC), having a minimum lateral safety margin of <3 mm, and localization in the upper third of the stomach were significantly associated with residual tumors. Multivariate analysis revealed that a lateral safety margin of <3 mm (OR 13.8; p < 0.001), PD (OR 16.3; p = 0.014), and SRC (OR 9.8; p = 0.009) among EGC patients, and severe IM in the background mucosa (OR 9.0; p = 0.024) among gastric adenoma patients, were significantly associated with residual tumors.


For neoplasms with undifferentiated histology (PD or SRC), short-term endoscopic follow-up may help to detect residual tumors that form after complete resection via ER. For EGC, the lateral margin may be considered safe if greater than 3 mm. However, the possibility of satellite lesions should be investigated when the gastric adenoma to be resected is surrounded by severe IM.


Endoscopic resection Gastric epithelial neoplasia Residual tumors Risk factors 



This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012R1A1A1042417).


Drs. Yun, Kim, Lee, Lee, Shin, Park, Chung, Park, Youn, and Park have no conflict of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Gak Won Yun
    • 1
  • Jie-Hyun Kim
    • 1
    Email author
  • Yong Chan Lee
    • 2
  • Sang Kil Lee
    • 1
  • Sung Kwan Shin
    • 2
  • Jun Chul Park
    • 2
  • Hyun Soo Chung
    • 2
  • Jae Jun Park
    • 1
  • Young Hoon Youn
    • 1
  • Hyojin Park
    • 1
  1. 1.Department of Internal Medicine, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  2. 2.Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulKorea

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