Role of Endoscopic Clipping for Determining the Resection Line for Tumors Located in the Middle or Upper Corpus of the Stomach: Experience with 100 Gastrectomies for Early Gastric Cancer

Background: The efficacy and limitations of pre-operative endoscopic clipping for determining the resection line in patients with early gastric cancer remain unclear. Materials and Methods: Subjects comprised 100 patients with early gastric cancer (33 females, 67 males; mean age, 60.5 years; range, 33-84 years) who underwent pre-operative endoscopic clipping for lesions located in the middle or upper corpus of the stomach. The results of endoscopic clipping for a selection of appropriate surgical procedures were investigated. Results: Distal gastrectomy was performed in 94 patients, the mean length between the lesion and proximal surgical margin of the resected stomach being 28.9 ±18.0 mm (mean ±SD). The surgical margin was eventually free of tumor in all patients. In 5 patients, clips were considered to be placed inadequately, and all 5 tumors were macroscopically depressed or flat and >40 mm in size. Conclusion: Pre-operative endoscopic clipping represents a safe and reliable procedure to determine the resection line for tumors located in the middle or upper corpus of the stomach for treatment of early gastric cancer. During surgical resection, frozen section examination of the proximal cut end is recommended for patients with tumors that are macroscopically depressed or flat and >40 mm in size, or that display a macroscopically unclear proximal margin.