Case 1 : This 46-year-old man underwent subtotal gastrectomy in 1991 for two IIc lesions. Endoscopy in 1994 revealed a polypoid lesion in the posterior wall of the gastric remnant, and biopsy results were positive for adenocarcinoma. The lesion was resected by endoscopic mucosal resection (EMR) . Pathological findings revealed well differentiated adenocarcinoma limited to the mucosal layer and the surgical margin was negative.
Case 2 : This 75-year-old man underwent subtotal gastrectomy for a IIa lesion in 1992. Endoscopy in 1994 revealed a polypoid lesion at the anastomotic site, and biopsy results were adenocarcinoma. Endoscopic ultrasonography (EUS) indicated that cancer was limited to the mucosal layer and EMR was performed. Pathological findings confirmed well differentiated adenocarcinoma limited to the mucosal layer and the surgical margin was negative.
In the Keio University Hospital, we have strict guidelines for local resection of primary gastric cancer : (1) the lesion must be limited to the mucosal layer, (2) protruding lesions must be smaller than 2.5 cm in diameter, (3) depressed lesions must be smaller than 1.5 cm in diameter and Ul (-) . The indications for EMR are even more limited ; smaller than 1 cm in diameter.
We have operated on 11 cases of early gastric remnant cancer thus far, and experienced only 1 case of lymph node metastasis in a submucosal cancer of a patient operated for gastric cancer 29 years before the second operation. There have been 124 reported cases of early cancer in the remnant stomach in Japan, and only 3 cases had lymph node metastasis, all submucosal cancers. For these reasons, we can regard EMR for early cancer in the remnant stomach as a good alternative to operation when performed along the same guidelines as primary early gastric cancer.
