Early additional endoscopic submucosal dissection in patients with positive lateral resection margins after initial endoscopic submucosal dissection for early gastric cancer

摘要

Endoscopic submucosal dissection (ESD) has become the standard treatment for early gastric cancer (EGC). Compared with EMR, ESD resects larger tumors en bloc, thereby permitting more precise pathologic assessment compared with piecemeal EMR. These features serve to justify the expanded use of ESD in patients with EGCs without clinical evidence of lymph node metastasis. Approximately 5% to 10% of patients undergoing ESD have incomplete resections, as follows: the presence of tumor in the resection margin and deep submucosal or lymphovascular invasion in the resected specimen. In these cases, gastrectomy has usually been performed for secondary treatment. Given the complications and consequent decrease in quality of life after surgery and recent advances in the ESD technique, early additional ESD may be another treatment option. There have been no reports of the usefulness of early additional ESD.