Abstract
Therapeutic efficacy of endoscopic mucosal resection (EMR) for early gastric cancer (EGC) less than 2cm in diameter was assessed with regard to the local recurrence and the survival of patients comparing with that in surgical cases. Twenty-four patients with 27 lesions were treated with EMR by en-block resection and followed up for more than 5 years. Of the 24, 19 were male and the rest 5 female. Mean age of these 24 cases was 65 years old. Of the 27 lesions, 25 were mucosal and the remaining 2 submucosal cancers. Histologically all of the 27 resected were well differentiated adenocarcinoma. The mean maximum diameter of EGC was 8.1mm.
“Complete resection”in which cut end of the specimen is free from cancerous invasion histologically was achieved in 18 (68%) of the 27 lesions. No local recurrence was detected from these 18 lesions. The rest 9 lesions of the 27 resulted in“incomplete resection”in which cancer cells were detected from the cut end of the specimen histologically. Of the 9 lesions, 6 were treated with additional EMR and/or laser endoscopy, 1 with gastorectomy and in the remaining 2 no cancer cells has been detected by biopsy from the ulcer or ulcer scar after the initial EMR for more than 5 years. The additional EMR and/or laser endoscopy was sucessfully done and local recurrence was not seen after the treatment, either. Five year survival rate of 24 EMR cases was 87.5% and that of the 234 surgical cases of mucosal cancer less than 2cm in diameter was 88.6%. In this series no one died of gastric cancer.
In conclusion, therapeutic efficacy of EMR can be assessed as almost equal to that of conventional surgery in case of mucosal cancer less than 2cm. With regard to the patient's quality of life, on the other hand, EMR provides more effective and beneficial outcome than comventional surgery, if we follow-up patients carefully after treatment.
