Evaluation of Remnant Gastric Cancer Surgically Resected after EMR

Yuichiro Ohigashi, Yukishige Yamada, Michihiro Narikiyo, Masatou Ueno, Hideki Uchida, Ryo Yoriki, Takashi Hachisuka, Takashi Mizuno and Yoshiyuki Nakajima

Department of Surgery, Nara Medical University

Endoscopic mucosal resection (EMR) is now widely used to treat early gastric cancer, and good results have been obtained. Frequent subsequent remnant lesions, however, complicate the decision of treatment. We evaluated remnant gastric cancer surgically resected after EMR and considered additional treatment for lesions. We also discuss the problem of extending indication of EMR. Patients and Methods: Subjects were 27 patients with 29 lesions undergoing surgical resection between January 1993 and February 2003 for remnant gastric cancer after EMR. We divided lesions into 3 groups based on reasons for EMR, i.e., 1) cases with absolute indication for EMR, 2) cases which EMR was tried for diagnosis, and 3) cases with relative indication for EMR. Results: 1) One case with an absolute indication of EMR advanced to MP invasion, and involved lymph node metastasis. This patient underwent gastrectomy 26 months later after EMR. 2) Most cases for which EMR was tried for diagnosis involved piecemeal resection. 3) One patient with poorly differentiated adenocarcinoma died of peritoneal recurrence after surgery. Summary: 1) In cases with an absolute indication for EMR, post-EMR remnant cancer should be resected by partial resection of the stomach. If long periods pass between EMR and surgery, gastrectomy with lymph node dissection is required. 2) Even if EMR is tried for diagnosis, it should involve a resection if possible. 3) Extending indication of EMR for undifferentiated carcinoma needs further investigation.

Key words
endoscopic mucosal resection (EMR), remnant lesions after EMR, indication for EMR, early gastric cancer, poorly differentiated adenocarcinoma

Reprint requests
Yuichiro Ohigashi Department of Surgery, Nara Medical University
840 Shijo-cho, Kashihara, 634-8522 JAPAN

Accepted
January 28, 2004

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