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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
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Endoscopic resection Gastric epithelial neoplasia Residual tumors Risk factors 

Notes

Acknowledgments

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).

Disclosures

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

References

  1. 1.
    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11PubMedCrossRefGoogle Scholar
  3. 3.
    Lambert R (2003) Treatment of esophagogastric tumors. Endoscopy 35:118–126PubMedCrossRefGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association. Gastric cancer treatment guidelines 2nd edition. Tokyo: Kanehara 2004. http://www.jgca.jp/PDFfiles/GL2004VER2.PDF.Accessed on February 26, 2010
  5. 5.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225PubMedCrossRefGoogle Scholar
  6. 6.
    Yoon H, Kim SG, Choi J, Im JP, Kim JS, Kim WH, Jung HC (2013) Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer. Surg Endosc 27:1561–1568PubMedCrossRefGoogle Scholar
  7. 7.
    Ryu KW, Choi IJ, Doh YW, Kook MC, Kim CG, Park HJ, Lee JH, Lee JS, Lee JY, Kim YW, Bae JM (2007) Surgical indication for non-curative endoscopic resection in early gastric cancer. Ann Surg Oncol 14:3428–3434PubMedCrossRefGoogle Scholar
  8. 8.
    Jung H, Bae JM, Choi MG, Noh JH, Sohn TS, Kim S (2011) Surgical outcome after incomplete endoscopic submucosal dissection of gastric cancer. Br J Surg 98:73–78PubMedCrossRefGoogle Scholar
  9. 9.
    Park JC, Lee SK, Seo JH, Kim YJ, Chung H, Shin SK, Lee YC (2010) Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience. Surg Endosc 24:2842–2849PubMedCrossRefGoogle Scholar
  10. 10.
    Watanabe H, Jass JR, Sobin LH (1990) Histological Typing of Oesophageal and Gastric Tumours: WHO International Histological Classification of Tumours, vol 18, 2nd edn. Springer, BerlinCrossRefGoogle Scholar
  11. 11.
    Lauren P (1965) The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma: an attempt at a histo-clinical classification. Acta Pathol Microbiol Scand 64:31–49PubMedGoogle Scholar
  12. 12.
    Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma-2nd English Edition. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  13. 13.
    Akahoshi K, Chijiwa Y, Hamada S, Sasaki I, Nawata H, Kabemura T, Yasuda D, Okabe H (1998) Pretreatment staging of endoscopically early gastric cancer with a 15 MHz ultrasound catheter probe. Gastrointest Endosc 48:470–476PubMedCrossRefGoogle Scholar
  14. 14.
    Yamashiro K, Suzuki H, Nagayo T (1977) Electron microscopic study of signet-ring cells in diffuse carcinoma of the human stomach. Virchows Arch A Pathol Anat Histol 374:275–284PubMedCrossRefGoogle Scholar
  15. 15.
    Maehara Y, Sakaguchi Y, Moriguchi S, Orita H, Korenaga D, Kohnoe S, Sugimachi K (1992) Signet ring cell carcinoma of the stomach. Cancer 69:1645–1650PubMedCrossRefGoogle Scholar
  16. 16.
    Mori M, Adachi Y, Kakeji Y, Korenaga D, Sugimachi K, Motooka M, Ooiwa T (1992) Superficial flat-type early carcinoma of the stomach. Cancer 69:306–313PubMedCrossRefGoogle Scholar
  17. 17.
    Nonaka K, Kita H (2013) Endoscopic Submucosal Dissection for Early Gastric Cancer. J Cancer Ther 4:26–32CrossRefGoogle Scholar
  18. 18.
    Abraham SC, Montgomery EA, Singh VK, Yardley JH, Wu TT (2002) Gastric adenomas: intestinal-type and gastric-type adenomas differ in the risk of adenocarcinoma and presence of background mucosal pathology. Am J Surg Pathol 26:1276–1285PubMedCrossRefGoogle Scholar

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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