Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? a large‐scale Korean multi‐center study

Abstract

Background and Objectives: To clarify optimal treatment guidelines for residual or local recurrence after endoscopic resection (ER). Methods: Eighty-six patients underwent gastrectomy due to incomplete ER and local recurrence after ER. The pathological findings of ER and gastrectomy specimens were analyzed. Results: The cause of gastrectomy was categorized into five groups; submucosal (sm) invasion without margin involvement, positive margin, margin not evaluable, high risk of lymph node metastasis and local recurrence after ER. According to the pathological findings of gastrectomy specimens, remnant cancer and lymph node metastases were found in 56 (65.1%) and in 5 patients (5.8%), respectively. At 10 gastrectomy specimens which were sm invasion without margin involvement, the scattered residual cancer cells were found around the ulcer scar in 2 (20%) patients. In 11 of 44 margin involvement specimens, no residual cancer or lymph node metastasis was found. In patients with local recurrence, mean duration from ER to surgery was 14.8 months, and 19% of patients were found to have sm or deeper depth of invasion. Conclusion: Gastrectomy with lymph node dissection should be performed in patients with sm invasion with or without margin involvement. However, minimal approach other than gastrectomy could further be applied to selected patients.

Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers

“…these criteria were obtained from studies that investigated pathological findings of gastrectomy specimens with LN dissection from a mostly Japanese dataset (7,10,11). to validate these criteria and the adequacy of er for egc, several studies have reported the clinical outcome of egcs treated with er (5,(12)(13)(14)(15). oda et al reported the clinical and surgical outcomes of 144 egcs, which were treated with er and underwent further surgical treatment due to the risk of ln metastasis.…”

Influence of endoscopic submucosal dissection on additional gastric resections

“…Generally, gastrectomy with lymph node dissection should be performed for patients with submucosal invasion with or without margin involvement after noncurative ESD [24]. However, it remains unclear whether a modified resection technique such as PG or PPG with D1 or D1?…”

Nanoscale iodized oil emulsion: a useful tracer for pretreatment sentinel node detection using CT lymphography in a normal canine gastric model

“…Even after the complete removal of the primary lesion by ESD, many patients require radical gastrectomy with LN dissection due to the risk of LN metastases [21,22]. However, pathological results after radical gastrectomy with LN dissection revealed that most of these patients did not have LN metastases [22].…”