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Pathological Evaluation Concerning Curability of Endoscopic Submucosal Dissection (ESD) of Early Gastric Cancer Including Lesions with Obscure Margins Hiroshi Tanabe 1,2 1Department of Pathology, Chikushi Hospital, Fukuoka University Keyword: 早期胃癌 , 内視鏡的粘膜下層剝離術 , 胃型粘液形質 , 一括完全切除 , 病変範囲診断 pp.53-66
Published Date 2006/1/25
DOI https://doi.org/10.11477/mf.1403100020
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 We investigated clinicopathologically the curability of 221 cases treated with ESD and measured the distance of burn degeneration at the cut ends to obtain a safety margin. We also evaluated pathologically the characteristics of lesions with obscure margins.

 Complete one-piece resection rate was evaluated as 84.2% (186/221), and piecemeal resection rate was 5.4% (12/221). The piecemeal resection rate of elevated type cancers〔10.3% (8/78)〕was significantly higher than that of the depressed type cancers〔3.0% (4/135)〕(p<0.05).

 The mean width of burn degeneration at the cut ends was 1,203μm. Compared with that of the other areas, the width of burn degeneration at the cut ends in the U-region was the longest (1,515μm).

 The clinicopathlogical characteristics of lesions with obscure margin were as follows : ( 1 )large lesions (31 mm≦), ( 2 )flat lesions or those with a flat area, ( 3 )adenocarcinoma with low-grade atypia, ( 4 )gastric mucin phenotype (G-type) adenocarcinoma or gastric predominant gastric and intestinal mucin phenotype (G>I-type) adenocarcinoma, ( 5 )carcinoma cells invading the middle to deeper portion of the mucosa under normal covering epithelium.

 According to the results, it is concluded that complete one-piece resection rate was 84.2%. The safety margin of ESD was evaluated as 2.0mm and gastric cancer with gastric mucin phenotype and cancer with low-grade atypia frequently showed an obscure margin.


Copyright © 2006, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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