Abstract
We focussed on problems of the following points in endoscopic mucosal resection (EMR) for early gastric carcinoma; techniques, indication and its extension, judgement and its criteria for complete resection (radicality), and follow-up. Curative EMR for cancer is performed with the aim of curing it. However, pretreatment evaluation of depth of the invasion is not always correct. For establishment of curative EMR as great as surgical treatment, it is inevitable to judge its curability based on definite criteria is histological examination of EMR specimen. Therefore, curative EMR is approved after the treatment. The curability should be judged based on definite criteria on the specimen of single (en bloc) EMR. The judgement of complete resection is impossible in the cases of piece meal EMR or additional EMR. Furthermore, the remnant and recurrence of cancer sometimes occur is these cases. Therefore, piece meal EMR and additional EMR are not acceptable as curative EMR. There is some doubt whether additional EMR and tissue destructive method are indicated as an additional treatment in the cases of possible remnant of cancer. Furthermore, there are problems of criteria for curability, and how to cope with noncurative cases. Regarding follow-up, there are many problems to solve including the following matters ; difficulty in performing strict follow-up, complexity of frequent endoscopies, difficulty in confirming remnant of cancer. Many efforts have been made to enlarge indication of EMR in terms of the size and depth of the lesion. So far, however, the resectable size with EMR is 3 cm in the maximum. At present, submucosal cancers are not indicated for curative EMR, taking accuracy of the diagnosis and risk for lymph node metastasis into account. Establishment of EMR as a curative treatment for cancer requires basic review of the following points from the viewpoints of radicality "as a principle of cancer treatment" : techniques, criteria for complete resection, measures against incomplete resection, and follow-up.
