Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multi-center study

Background and Objectives: To clarify optimal treatment guidelines for residual or local recurrence after endoscopic resection (ER). Methods: Eighty-six patients underwent gastrectomy due to incomplete ER and local recurrence after ER. The pathological findings of ER and gastrectomy specimens were analyzed. Results: The cause of gastrectomy was categorized into five groups; submucosal (sm) invasion without margin involvement, positive margin, margin not evaluable, high risk of lymph node metastasis and local recurrence after ER. According to the pathological findings of gastrectomy specimens, remnant cancer and lymph node metastases were found in 56 (65.1%) and in 5 patients (5.8%), respectively. At 10 gastrectomy specimens which were sm invasion without margin involvement, the scattered residual cancer cells were found around the ulcer scar in 2 (20%) patients. In 11 of 44 margin involvement specimens, no residual cancer or lymph node metastasis was found. In patients with local recurrence, mean duration from ER to surgery was 14.8 months, and 19% of patients were found to have sm or deeper depth of invasion. Conclusion: Gastrectomy with lymph node dissection should be performed in patients with sm invasion with or without margin involvement. However, minimal approach other than gastrectomy could further be applied to selected patients.