2004 Volume 46 Issue 7 Pages 1382-1387
Background ; Endoscopic mucosal resection (EMR) is widely accepted as a minimally invasive treatment for early gastric cancer (EGC) in Japan. However the criteria for EMR must be strictly adhered to otherwise patients will miss the chance for additional therapy. We assess the important factor in expanding the indication of EMR. Methods ; we investigated 1101 EGCs which had been resected by EMR at the National Cancer Center Hospital (NCCH) according to the indication recommended by Japanese Gastric Cancer Association (JGCA) and the expanded indication proposed by NCCH. Curability and local recurrence of the EMRs were assessed related to the applied indication and the number of resected specimens. Results ; The recurrence rate of non-evaluable resection was higher than that of evaluable resection (p<0.0001). 83 lesions among 772 leisons in the JGCA group were non-evaluable. 37 leisons among 329 lesions in the NCCH group were non-evaluable. There was no difference in the rate of non-evaluable resection between JGCA and NCCH groups (p=0.8329). However the rate of curative resection was lower in the NCCH group than in the JGCA group (p=0.0009). In piecemeal resection, there was no difference in the rate of non-evaluable resection between JGCA and NCCH groups (p=0.0527). In one-piece reseection, the rate of non -evaluable resection was lower in NCCH group than JGCA group (p=0.0137). Conclusion ; Based on our series of cases we propose one-piece resection as a gold standard for EMR. Because it enables accurate histological evaluation even in the EMR according to the expanded indication.
