1997 Volume 50 Pages 160-163
Nineteen cases with early gastric cancer were treated with salvage gastrectomy after endoscopic mucosal resection (EMR) in Keio University Hospital from 1990 to 1995. The residual cancer cells and lymph node metastasis were evaluated in comparing with the findings of EMR-specimens.
Macroscopic findings included one type I case, seven type IIa cases, nine type IIc cases, one IIa＋IIb case, and one type IIa＋IIc case. Histologically, 9 cases were well, 9 cases were moderately, and one case was poorly differentiated adenocarcinoma. The depth of the tumor invasion were mucosal cancer for nine cases, and the other ten cases had submucosal invasion. The reasons for salvage gastrectomy were'positive surgical margin’for 7 cases,'unclear surgical margin’for 2 cases, and'submucosal invasion with positive surgical margin’for 10 cases.
In the resected specimens, the remnant cancer cells were observed in seven of nine cases (78%) for mucosal cancer, and eight of ten cases (80%) for submucosal cancer. Lymph node metastasis was found in only one case of 78-year-old male out of ten submucosal cancer cases. Although this case had positive surgical margin with submucosal invasion in the EMR-specimen, the salvage operation was not performed and the laser irradiation was added because of poor respiratory ability and the patients choice. While no cancer cells were obtained in the follow-up gastrofiberscopy for 22 months after the initial EMR, the patient developed common biliary duct stones (CBDS) . And since the preoperative gastrofiberscopy proved Group IV cells in the EMR-scar, the distal gastrectomy was performed combined with the extirpations of CBDS. The surgical specimen showed the subserosal invasion with positive lymph nodes metastasis in the second group.
When the surgical margin of the EMR-specimens was positive, the additional surgical resection should be performed, because the cancer cells would remain around the lesions. Our indication for EMR includes well differentiated type, mucosal invasion, no ulceration, and size less than 10 mm, which warrants complete resection the lesion by the single EMR.
