Review of No Residual Tumors after Additional Endoscopic Treatments with only Positive Lateral Margin after Endoscopic Submucosal Dissection for Early Gastric Cancer

Aims Endoscopic treatment as additional therapy for noncurative resection in the only positive lateral margin (pLM) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has been recommended in patients with no risk of lymph node metastasis because it is less invasive than surgical gastrectomy with favorable long-term outcome. However, there is no guideline on how to perform follow-up observation until additional ESD is performed.

Methods We retrospectively analyzed 161 patients with only pLM after ESD for EGC who had undergone at least 2 years of follow up.

Results Of the 161 patients, 148 patients were undergone endoscopic follow-up biopsy group and 13 patients were directly undergone additional treatment without further biopsy confirmation. In directly undergone additional treatment group (n=13), 9 cases of no residual tumor were determined (9/13, 69.2%); 3 out of 3 in additional ESD (3/3, 100%), 3 out of 4 in biopsy and argon plasma coagulation (APC) (75%), and 3 out of 6 in surgical resection (50%). However, in endoscopic follow-up biopsy group, 121 patients showed no recurrence at least 2 years follow up. Twenty two patients (22/148, 14.9%) were confirmed positive on resection ulcer margin. Twenty patients underwent 2^nd ESD, two in APC, and one in surgical resection. Only one case of no residual tumor was determined among 20 cases of 2^nd ESD.

Conclusions Additional treatment after endoscopic follow up biopsy confirmation could be a proper treatment strategy in patients with only positive lateral margin after ESD for EGC who has no risk factors for lymph node metastasis.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023