Indication for Curative Endoscopic Mucosal Resection for Early Gastric Cancer: Analysis of 290 Surgical Cases

Misumi, Atsunobu; Murakami, Akinobu; Hirata, Toshihiko; Kako, Hirofumi; Arima, K; Honmyo, Ubehiko; Mizumoto, Seiichi; Yoshinaka, Ichiro; Ohshima, Shigeki; Ogawa, Michio

doi:10.1007/978-4-431-68252-3_94

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“…Therefore, it is important, in performing radical EMR, to obtain histologically sufficient cancer-free mucosa at the stump of the EMR specimen, 2 mm or more from the main lesion, as we have reported previously. 16 > Some endoscopists recommend endoscopic laser or heat probe coagulation therapy, as an adjunctive endoscopic treatment for the remaining cancerous lesion at the stump and for those with an insufficient cancer-free margin. 15 > However, it is very difficult to assess radicality after these therapies.…”

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confidence: 99%

A Clinicopathological Study on Surgically Resected Stomachs in Patients with Preceding Endoscopic Mucosal Resection for Early Gastric Cancer

Honmyo

Misumi²,

Murakami³

et al. 1996

Digestive Endoscopy

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We performed a clinicopathological study on surgical gastrectomy specimens in 19 patients who were operated on after endoscopic mucosal resection (EMR) which had been performed in an attempt to attain a radical cure of early gastric cancer. The surgical specimens were scrutinized for the purpose of evaluating the preceding EMR. The indications for surgical resection were extension of cancerous tissue to the mucosal stump or submucosal invasion in the EMR specimens, and residual cancer confirmed by follow‐up biopsy. Cancerous tissue was noted at the mucosal stump in the EMR specimen in 14 cases, among whom 12 (85. 7%) had remnant cancer in the mucosa of the resected stomach. In one case that had shown a cancer‐free distance of 1 mm at the mucosal stump of the EMR specimen, cancer was found in the mucosa of the resected stomach. Submucosal invasion was observed in the EMR specimen in 12 cases, among whom nine (75.0%) had nests of cancerous tissue left in the resected stomach. This study suggests that it is important in conducting radical EMR to ensure sufficient (2 mm or greater) cancer‐free mucosa at the margins. In other words, subsequent gastrectomy should be performed whenever cancer‐free margins of the EMR specimens are considered insufficient. It is also suggested that in cases with submucosal invasion, EMR inherently carries a high risk of incomplete excision leaving cancerous tissue and/or metastasis. More extensive surgery with lymph node dissection is indicated in such cases. (Dig Endosc 1996 ; 8 : 192‐198)

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confidence: 99%