[Treatment of noncurative endoscopic resection - experience of Japanese National Cancer Center]
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The rate of non-curative resection differs depending on the indication of endoscopic resection, the techniques such as ESD or EMR with precutting, and the pathological criteria. In the large clinical series from Japanese National Center Center, the rate of non-curative resection was sixteen percent. Noncurative cases were further divided into positive lateral margin only group and possible risk of lymph node metastasis group.
This is the surgical outcome. Local residual tumor was found in 47% of patients from positive lateral margin group and 4% from the risk of lymph node metastasis group. Lymph node metastasis was found in only the risk of lymph node metastasis group.
This is the long term followup result. In the positive lateral margin only group, 53 out of 72 patients were treated non-surgically, such as just followup, ablation, or additional ESD. There was no gastric cancer-related death.
In the risk of lymph node metastasis group, patients were usually treated by surgery. There was 5 gastric cancer-related death. Among them, three gastric cancer-related mortalities developed even after additional surgery.