Indication and Limitation of Endoscopic Surgery of Early Gastric Cancer. An Analysis of 290 Early Cancers Operated on and 65 Early Cancers Treated Endoscopically.

Misumi, Atsunobu; Mizumoto, Seiichi; Misumi, Katsuki; Harada, Kazunori; Kako, Hirofumi; Honmyo, Ubehiko; K, Arima; Yoshinaka, Ichiro; Maeda, Masaomi; Ogawa, Michio

doi:10.5833/jjgs.24.2610

Cited by 5 publications

(3 citation statements)

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“…Piecemeal endoscopic mucosal resection often results in incomplete resection in which a surgical margin of the specimen is histologically unclear. It has been reported that the recurrence rate for incomplete endoscopic resection of a lesion is as high as 42% to 67% [13,14]. Therefore laparoscopic surgery is preferable for the treatment of mucosal gastric cancer over endoscopic mucosal resection if the size of the lesion is more than 10 mm or the site of the lesion is near the cardia where endoscopic mucosal resection is technically difficult to apply.…”

Section: Discussionmentioning

confidence: 99%

“…Although this method is minimally invasive, its application is limited by the site and size of the lesion when attempting a complete cure. The average diameter of the specimen during endoscopic mucosal resection is about 16 mm; more than 2 mm of cancer clearance in the specimen is recommended to reduce recurrence [12,13]. Piecemeal endoscopic mucosal resection often results in incomplete resection in which a surgical margin of the specimen is histologically unclear.…”

Section: Discussionmentioning

confidence: 99%

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Curative Laparoscopic Surgery for Early Gastric Cancer: Five Years Experience

et al. 1999

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Sixty-one patients who were diagnosed with mucosal gastric cancer have been successfully treated with two laparoscopic techniques at our institute from March 1992 to March 1997. One is laparoscopic wedge resection of the stomach using a lesion-lifting method for lesions of the anterior wall, the lesser curvature, and the greater curvature of the stomach. The other is laparoscopic intragastric mucosal resection for lesions of the posterior wall of the stomach and near the cardia or the pylorus. Indications are as follows: (1) preoperatively diagnosed mucosal cancer; (2) <25 mm diameter elevated lesions; and (3) <15 mm diameter depressed lesions without ulcer formation. Patients were discharged in 4 to 8 days uneventfully. There was no major complication or mortality. The resected specimens had sufficient surgical margins horizontally (16 +/- 5 and 8 +/- 4 mm, respectively) and vertically. In one patient histologic examination revealed slight tumor infiltration into the submucosal layer with lymphatic invasion. He underwent gastrectomy with lymph node dissection 1 month after surgery. Otherwise, histologic examination revealed curative surgery. All patients in the series have survived during the 4- to 65-month follow-up period. There have been two recurrences in the series, both of which were found near the staple line 2 years after the initial surgery and were still mucosal lesions. They were successfully treated by open gastrectomy and laser irradiation. A separate early gastric cancer was found 2 years after the initial surgery in one patient, who then underwent curative open gastrectomy. In conclusion, if the patients are selected properly, these laparoscopic procedures are curative, minimally invasive treatment for early gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Curative Laparoscopic Surgery for Early Gastric Cancer: Five Years Experience

et al. 1999

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“…The complete resection rate by EMR is 60-80% [13,14]. It has been reported that the recurrence rate for incomplete endoscopic resection of a lesion is 42%-67% [1,6]. There are few reports on the treatment for local recurrence lesions of early gastric cancer after EMR.…”

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confidence: 98%

Laparoscopic management for local recurrence of early gastric cancer after endoscopic mucosal resection

et al. 2005

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Endoscopic mucosal resection (EMR) is a widely accepted technique for early gastric cancer because it is minimally invasive; however, incomplete resection with subsequent cancer recurrence in the remnant remains a difficult problem. Generally, the margins of the local recurrence lesions are unclear, and second EMR is difficult to perform because of scar formation after the first EMR. We performed a laparoscopic treatment on six patients with residual lesions after EMR and reviewed the safety and efficacy of this management. Laparoscopic management consisted of two techniques: laparoscopic wedge resection with a lesion-lifting method and laparoscopic-assisted distal gastrectomy with mini-laparotomy. Cancerous lesions were completely resected with sufficient surgical margins circumferentially. Mean operative time was 171 min, mean estimated blood loss was 16.5 g, time to first walking was 1 day, duration of epidural analgesia was 2.2 days, and mean length of hospital stay was 13.5 days. There were no intra- and postoperative complications, no conversion to open surgery, and no recurrence after surgery. No patients died of gastric cancer during a median follow-up of 60.3 months (range, 38-84). Laparoscopic management for residual lesions of early gastric cancer after EMR is a safe, effective, and minimally invasive procedure by which curative resection can be expected.

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