Skip to main content
Log in

The Role of Surgery After Incomplete Endoscopic Mucosal Resection for Early Gastric Cancer

  • Published:
Surgery Today Aims and scope Submit manuscript



Endoscopic mucosal resection (EMR) is a relatively new treatment option for early gastric cancer (EGC). However, cases of incomplete EMR resulting in a positive lateral margin or submucosal invasion (positive vertical margin) have been reported. We conducted this study to evaluate the role of surgery after incomplete EMR for EGC.


We analyzed 19 patients who underwent gastrectomy as a result of an incomplete EMR. The patients were divided into three groups according to the type of incomplete EMR: a positive lateral margin (LM) group (n = 9), a positive vertical margin (VM) group (n = 4), and a positive lateral and vertical margin (LM + VM) group (n = 6).


The positive residual tumor rate and the positive lymph node rate were 44.4% (4/9) and 0% (0/9) in the LM group, 50.0% (2/4) and 25.0% (1/4) in the VM group, and 83.3% (5/6) and 16.7% (1/6), LM + VM group, respectively. Curative resection was performed in all patients and there was no recurrence in 30.8 months of follow-up.


Radical surgery is recommended for patients with a positive lateral resection margin or submucosal invasion, or both, after EMR for EGC, because of the possibility of residual tumor or lymph node metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. K Shibuya CD Mathers C Boschi-Pinto AD Lopez CJ Murray (2002) ArticleTitleGlobal and regional estimates of cancer mortality and incidence by site: II. Results for the global burden of disease 2000 BMC Cancer 2 37 Occurrence Handle12502432 Occurrence Handle10.1186/1471-2407-2-37

    Article  PubMed  Google Scholar 

  2. Central Cancer Registry in Korea. Annual report of the Central Cancer Registry in Korea. Seoul: Ministry of Health and Welfare, Republic of Korea; 2001

  3. CJ van de Velde KC Peeters (2003) ArticleTitleThe gastric cancer treatment controversy J Clin Oncol 21 2234–6 Occurrence Handle12805321 Occurrence Handle10.1200/JCO.2003.91.138

    Article  PubMed  Google Scholar 

  4. HK Lee HK Yang WH Kim KU Lee KJ Choe JP Kim et al. (2001) ArticleTitleInfluence of the number of lymph nodes examined on staging of gastric cancer Br J Surg 88 1408–12 Occurrence Handle11578301 Occurrence Handle10.1046/j.0007-1323.2001.01875.x Occurrence Handle1:STN:280:DC%2BD3Mrjt1SmtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. S Shimada Y Yagi K Shiomori U Honmyo N Hayashi A Matsuo et al. (2001) ArticleTitleCharacterization of early gastric cancer and proposal of the optimal therapeutic strategy Surgery 129 714–9 Occurrence Handle11391370 Occurrence Handle10.1067/msy.2001.114217 Occurrence Handle1:STN:280:DC%2BD3MzitVOiuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  6. H Itoh Y Oohata K Nakamura T Nagata R Mibu F Nakayama (1989) ArticleTitleComplete ten-year postgastrectomy follow-up of early gastric cancer Am J Surg 158 14–6 Occurrence Handle2742043 Occurrence Handle10.1016/0002-9610(89)90305-X Occurrence Handle1:STN:280:DyaL1MzgtV2muw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. S Abe Y Ogawa N Nagasue Y Sasaki H Akamizu S Hirose et al. (1984) ArticleTitleEarly gastric cancer results in a general hospital in Japan World J Surg 8 308–14 Occurrence Handle6464487 Occurrence Handle10.1007/BF01655060 Occurrence Handle1:STN:280:DyaL2c3ns1aluw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  8. SK Chang NS Paik NM Moon JI Lee DW Choi HY Bang (1996) ArticleTitleAnalysis of recurrence and survival rate in early gastric cancer patients J Korean Cancer Assoc 28 1021–31

    Google Scholar 

  9. HJ Lee YH Kim WH Kim KU Lee KJ Choe JP Kim et al. (2003) ArticleTitleClinicopathological analysis for recurrence of early gastric cancer Jpn J Clin Oncol 33 209–14 Occurrence Handle12865463 Occurrence Handle10.1093/jjco/hyg042

    Article  PubMed  Google Scholar 

  10. Y Adachi N Shiraishi S Kitano (2002) ArticleTitleModern treatment of early gastric cancer: review of the Japanese experience Dig Surg 19 333–9 Occurrence Handle12435900 Occurrence Handle10.1159/000065829

    Article  PubMed  Google Scholar 

  11. T Sano O Kobori T Muto (1992) ArticleTitleLymph node metastasis from early gastric cancer: endoscopic resection of tumor Br J Surg 79 241–4 Occurrence Handle1313325 Occurrence Handle1:STN:280:DyaK383gvVOhsg%3D%3D

    PubMed  CAS  Google Scholar 

  12. H Ono H Kondo T Gotota K Shirao H Yamaguchi D Saito et al. (2001) ArticleTitleEndoscopic mucosal resection for treatment of early gastric cancer Gut 48 225–9 Occurrence Handle11156645 Occurrence Handle10.1136/gut.48.2.225 Occurrence Handle1:STN:280:DC%2BD3M7is1Wguw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  13. K Nakamura T Morisaki A Sugitani T Ogawa A Uchiyama N Kinukawa et al. (1999) ArticleTitleAn early gastric carcinoma treatment strategy based on analysis of lymph node metastasis Cancer 85 1500–5 Occurrence Handle10193939 Occurrence Handle10.1002/(SICI)1097-0142(19990401)85:7<1500::AID-CNCR10>3.0.CO;2-8 Occurrence Handle1:STN:280:DyaK1M3gvVarsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. M Kida S Tanabe K Saigenji (2003) ArticleTitleEndoscopic mucosal resection for gastric cancer: Necessity of ‘Incision and stripping method’ and present status Dig Endosc 15 S15–8 Occurrence Handle10.1046/j.1443-1661.15.s.5.x

    Article  Google Scholar 

  15. K Takeshita M Tani H Inoue I Saeki S Hayashi T Honda et al. (1997) ArticleTitleEndoscopic treatment of early oesophageal or gastric cancer Gut 40 123–7 Occurrence Handle9155589 Occurrence Handle1:CAS:528:DC%2BD3cXivV2qu78%3D

    PubMed  CAS  Google Scholar 

  16. T Gotoda A Yanagisawa M Sasako H Ono Y Nakanishi T Shimoda et al. (2000) ArticleTitleIncidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases a two large centers Gastric cancer 3 219–25 Occurrence Handle11984739 Occurrence Handle10.1007/PL00011720

    Article  PubMed  Google Scholar 

  17. H Nagano S Ohyama T Fukunaga Y Seto J Fujisaki T Yamaguchi et al. (2005) ArticleTitleIndications for gastrectomy after incomplete EMR for early gastric cancer Gastric cancer 8 149–54 Occurrence Handle16086117 Occurrence Handle10.1007/s10120-005-0328-5

    Article  PubMed  Google Scholar 

  18. D Korenaga H Orita S Maekawa A Maruoka K Sakai T Ikeda et al. (1997) ArticleTitlePathological appearance of the stomach after endoscopic mucosal resection for early gastric cancer Br J Surg 84 1563–6 Occurrence Handle9393280 Occurrence Handle10.1002/bjs.1800841120 Occurrence Handle1:STN:280:DyaK1c%2FlsV2qsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. Y Maehara Y Kakeji S Oda I Takahashi K Akazawa K Sugimachi (2000) ArticleTitleTime trends of surgical treatment and the prognosis for Japanese patients with gastric cancer Br J Cancer 83 986–91 Occurrence Handle10993643 Occurrence Handle10.1054/bjoc.2000.1427 Occurrence Handle1:STN:280:DC%2BD3M%2FhvVOruw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  20. InstitutionalAuthorNameKorean Gastric Cancer Association (2002) ArticleTitleNationwide gastric cancer report in Korea J Korean Gastric Cancer Assoc 2 105–14

    Google Scholar 

  21. E Capka C Jürgensen C Koska G Kulamarva A Tannapfel U Stölzel (2003) ArticleTitleEndoscopic aspiration mucosectomy: A possibility for curative therapy of early gastric cancer Dig Dis Sci 48 1088–93 Occurrence Handle12822867 Occurrence Handle10.1023/A:1023760627955 Occurrence Handle1:STN:280:DC%2BD3s3psFarsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  22. H Inoue N Fukami T Yoshida S Kudo (2002) ArticleTitleEndoscopic mucosal resection for esophageal and gastric cancer J Gastroenterol Hepatol 17 382–8 Occurrence Handle11982716 Occurrence Handle10.1046/j.1440-1746.2002.02732.x

    Article  PubMed  Google Scholar 

  23. S Folli P Morgagni F Roviello GD Manzoni D Marrelli L Saragoni et al. (2001) ArticleTitleRisk factors for lymph node metastases and their prognostic significance in early gastric cancer for the Italian research group for gastric cancer (IRGGC) Jpn J Clin Oncol 31 495–9 Occurrence Handle11696619 Occurrence Handle10.1093/jjco/hye107 Occurrence Handle1:STN:280:DC%2BD3MnltFKitg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  24. N Kurihara T Kubota Y Otani M Ohgani K Kumai H Sugiura et al. (1998) ArticleTitleLymph node metastases of early gastric cancer with submucosal invasion Br J Surg 85 835–9 Occurrence Handle9667719 Occurrence Handle10.1046/j.1365-2168.1998.00743.x Occurrence Handle1:STN:280:DyaK1czjtVaqsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  25. H Noshiro E Nagai S Shimizu A Uchiyama M Tanaka (2005) ArticleTitleLaparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer Surg Endosc 19 1592–6 Occurrence Handle16247578 Occurrence Handle10.1007/s00464-005-0175-9 Occurrence Handle1:STN:280:DC%2BD2MnivVWhtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  26. S Tanimura M Higashino Y Fukunaga S Kishida M Nishikawa A Ogata et al. (2005) ArticleTitleLaparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer Surg Endosc 19 1177–81 Occurrence Handle16132317 Occurrence Handle10.1007/s00464-004-8936-4 Occurrence Handle1:STN:280:DC%2BD2Mrnt1ehsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  27. H Yano Y Kimura T Iwazawa T Mondon (2005) ArticleTitleLaparoscopic management for local recurrence of early gastric cancer after endoscopic mucosal resection Surg Endosc 19 981–5 Occurrence Handle15868263 Occurrence Handle10.1007/s00464-004-8172-y Occurrence Handle1:STN:280:DC%2BD2MvotFKmtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  28. SY Park KJ Lee CK Cha JH Kim KB Hahm SW Cho (2001) ArticleTitleThe usefulness of endoscopic ultrasonography and endoscopy in diagnosing depth of invasion of early gastric cancer for the selection of proper candidates for endoscopic mucosal resection Korean J Gastrointest Endosc 23 437–44

    Google Scholar 

  29. CH Chen CC Yang YH Yeh (2002) ArticleTitlePreoperative staging of gastric cancer by endoscopic ultrasound J Clin Gastroenterol 35 321–7 Occurrence Handle12352295 Occurrence Handle10.1097/00004836-200210000-00008

    Article  PubMed  Google Scholar 

  30. ID Norton DB Jones (2003) ArticleTitleEndoscopic ultrasound: diagnostic and therapeutic application Int Med J 33 26–32 Occurrence Handle10.1046/j.1445-5994.2003.00338.x Occurrence Handle1:STN:280:DC%2BD3s%2FivVCqtw%3D%3D

    Article  CAS  Google Scholar 

  31. S Ohashi K Segawa S Okamura M Mitake H Urano M Shimodaira et al. (1999) ArticleTitleThe utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer Gut 45 599–604 Occurrence Handle10486372 Occurrence Handle1:STN:280:DyaK1MvhslKmsQ%3D%3D Occurrence Handle10.1136/gut.45.4.599

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Additional information

This paper was presented at the 76th Annual Meeting of the Japanese Gastric Cancer Association, Yonago, Japan, March 4–6, 2004.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chung, Y., Park, DJ., Lee, HJ. et al. The Role of Surgery After Incomplete Endoscopic Mucosal Resection for Early Gastric Cancer. Surg Today 37, 114–117 (2007).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words