The Importance of Histological Evaluation and the Necessity of One-piece Resection for Endoscopic Gastric Mucosal Resection Takuji Gotoda 1 , Hiroyuki Ono 2 , Ichiro Oda 1 1Department of Endoscopy, National Cancer Center Hospital 2Department of Gastroenterology, Shizuoka Cancer Center Keyword: EMR , 胃癌治療ガイドライン , 適応拡大 , 一括切除 , ITナイフ pp.1145-1154
Published Date 2002/8/25
DOI https://doi.org/10.11477/mf.1403104522
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 It is well known that EMR allows us to perform less invasive but curative treatment. At the National Cancer Center Hospital, endoscopic mucosal resection (EMR) is applied in patients with early gastric cancers up to 30 mm in size that are well or moderately differentiated in type regardless of ulceration or more than 30 mm if there is no ulceration, but definite signs of submucosal invasion. This means that the patients with such cancers have a low risk of lymph-node metastasis.

 From 1987 to 2001, 1,101 lesions were treated by EMR. The curative resection rate was 72% (793/1,101). One hundred and twenty lesions (11%) were classified into a not-evaluable group. Among the tumors resected in one piece, 81% (647/799) were curative, resections, and 4% were in the not-evaluable group. When the tumors were removed by multiple fragments, 146 tumors (48%) were histologically confirmed as curative resections, but 5 local recurrences (3%) developed in the fragmented curative resections compared with no residual cancers in the one-piece curative group. The insulation-tipped electrosurgical knife (IT knife) is providing excellent therapeutic resects. In the last 2 years, 96% of the tumors (372/388) were resected in one piece using this procedure.

 The endoscopic distinction between mucosal and submucosal invasion is made correctly in only approximately 80% of cases, which means that the pretreatment diagnosis would be incorrect for 20% of the tumors that are candidates for EMR. Accurate histological examination of the specimen resected by EMR is essential for correct surveillance. One piece resection makes possible a correct recommendation for patients with early gastric cancer.

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