Sa1528 Efficacy and Curability of Retroflexion−Assisted EMR(R-EMR) for Large LSTS in Low Rectum

cancer (EGC) and investigated the incidence and patterns of recurrence in patients who underwent non-curative endoscopic resection without additional treatment for differentiated EGC. Patients and Methods: We performed a retrospective review of prospectively and consecutively collected database of differentiated EGCs undergone noncurative endoscopic resection without additional treatment for EGCs from April 2000 to June 2011. Results: A total of 345 patients underwent noncurative endoscopic resection for 347 differentiated EGCs. Patients without additional treatment tended to be older (median age 70 years vs. 63 years, p!0.01). They underwent additional surgery in 232 EGCs, additional ER in 12 EGCs, and additional APC in 7 EGCS. Ninety six patients (97 EGCS) didn’t undergo additional treatment. Among 29 EGCs with positive resection margin, seven EGCs revealed remained lesion in the follow up endoscopic biopsy. Among 97 EGCs without additional treatment, extragastric recurrence occurred in five EGC cases at mean 32 months (range 25-40 months), and all of them initially had lymphovascular invasion (LVI) or deep submucosal (SM) invasion (Figure 1). Among 250 EGCs with additional treatment, extragastric recurrence occurred only in one case at 20 months after additional surgery. The median follow up period was 32 months (range 0-99.7 months). The overall 5-year survival rate was 94.7 % in the no additional treatment group and 97.8% in the additional treatment group. Of 347 patients, nine patients died during follow up period. Among them, two patients died of stomach cancer. Conclusions: Recurrence rates was higher in patients without additional treatment than in patients with additional surgery (6.2% vs. 0.4%). Recurrence mainly occurred in patients with lymphovascular invasion (LVI) and submucosal (SM) invasion. Therefore additional treatment should be considered in patients with LVI and SM invasion among patients undergone noncurative endoscopic resection for EGC. The overall survival rates between patients with and without additional surgery after non-curative endoscopic resection for EGC were not significantly different. Therefore, in elderly patients at high risk for surgery, conservative strategy with intensive surveillance could be considered.