Original Article: Clinical Endoscopy
EMR for early gastric cancer in Korea: a multicenter retrospective study

https://doi.org/10.1016/j.gie.2007.04.013Get rights and content

Background

EMR has been accepted as a treatment modality for selected cases of early gastric cancer (EGC) in Japan. However, long-term outcomes after EMR for EGC have not been fully documented.

Objectives

We reviewed the experiences of EMR for EGC in Korea, with emphasis on the long-term outcome.

Design

Multicenter, retrospective study.

Methods

Data were collected retrospectively by use of the on-line database registry system. From January 2000 to December 2002, 514 EGCs in 506 patients were treated by EMR in 13 institutions in Korea. Median age of the patients was 60 years (range 45-83 years). The resection was regarded as incomplete if histopathologic examination revealed a positive resection margin or submucosal invasion or positive lymphovascular invasion or undifferentiated histologic diagnosis.

Results

The most commonly used technique was circumferential precutting followed by snare resection (EMR-P, n = 269, 52.3%). Complete resection and incomplete resection after EMR were confirmed in 399 lesions (77.6%) and 103 lesions (20.0%), respectively. For completely resected mucosal cancers (n = 399), the median duration of follow-up was 23.5 months (range 5-70 months). In this group, local recurrence was detected in 24 cases (6.0%) with a median interval between EMR and recurrence of 17.9 months (range 3.5-51.7 months). There were 3 cases with perforation and 71 cases with bleeding. No deaths were related to recurrence of gastric cancer during the overall median follow-up period of 39 months.

Limitations

Multicenter retrospective design, no controls.

Conclusions

EMR is an effective therapeutic modality for selected cases of EGC in Korea.

Section snippets

Patients and methods

Clinicopathologic data of 506 patients who underwent gastric EMR for EGC between January 2000 and December 2002 at 13 university hospitals in Korea were retrospectively collected. Analyzed factors included age, sex, family history of gastric cancer, Helicobacter pylori infection, EMR technique, en bloc or piecemeal resection, number of tumors, location of the tumor, macroscopic type of the tumor, tumor size, lateral resection margin, depth of tumor invasion, histologic type, lymphatic

Clinicopathological characteristics of tumors

The microscopic types according to the size of 514 lesions are listed in Table 1. Two hundred twenty-five lesions (43.8%) were the elevated type, 237 lesions (46.1%) were the flat or depressed type, and 52 lesions (10.1%) were the mixed type (Table 1). The location of EGC was the antrum in 339 lesions (66.0%), the angle in 78 lesions (15.2%), the lower body in 54 lesions (10.5%), the mid body in 17 lesions (3.3%), the upper body in 16 lesions (3.1%), the cardia in 8 lesions (1.6%), and the

Discussion

On account of quality of life and less invasiveness, EMR has become a popular treatment for EGC in countries with high prevalence of gastric cancer. The number of patients undergoing EMR is increasing in Korea as well as in Japan.5 However, results of EMR in countries other than Japan have been very rarely reported. This is the first multicenter clinical study examining the outcome of EMR for EGC in Korea. During a 3-year period, 514 EGC lesions were resected endoscopically in 13 institutions

References (18)

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Current affiliations: Department of Medicine, Sungkyunkwan University School of Medicine (J. J. K., J. H. L.), Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center (H.-Y. J., G. H. L.), Department of Internal Medicine, Soon Chun Hyang University College of Medicine (J.Y.C., C.B.R.), Department of Internal Medicine, Korea University College of Medicine (H.J.C., J.J.P.), Department of Internal Medicine, Inje University College of Medicine (J.S.M.), Department of Internal Medicine, Seoul National University College (Y.B.Y.), Seoul, Department of Internal Medicine, Chonnam National University College of Medicine (W.S.L.) Gwangju, Department of Internal Medicine, Yonsei University Wonju College of Medicine (H.S.K.), Wonju, Department of Internal Medicine, Gachon Medical School (M.G.C.), Incheon, Department of Internal Medicine, Dong-A University (S.R.C.), Department of Internal Medicine, Busan National University College of Medicine (G.A.S.), Department of Internal Medicine, Inje University Busan Paik Hospital (S.R.J., S.Y.S.), Busan, Department of Internal Medicine, Chungnam National University College of Medicine (H.Y.J.), Taejeon, Korea

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Copyright © 2007 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.