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Clinical Study of Invasive Gastric Cancer Patients Who Underwent Surgical Operations after Endoscopic Mucosal Resection (EMR) Yoshifumi Yokoyama 1 , Mitsuki Miyata 1 , Makoto Itoh 1 1The First Department of Internal Medicine, Nagoya City University, School of Medicine Keyword: 胃癌 , sm癌 , 内視鏡的粘膜切除術 , sm細分類 pp.1717-1723
Published Date 1997/12/25
DOI https://doi.org/10.11477/mf.1403105266
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 Recently, endoscopic mucosal resection (EMR) method has made it possible to carry out radical resection for small gastric mucosal cancers in resectable cases. The indications for performing EMR instead of surgery were determined pathologically as follows; (1) Eleveted type of cancer measuring 2 cm or less in size, (2) Depressed type of cancer without ulceration measuring 1 cm or less in size, (3) Differentiated type of mucosal carcinoma. Following those indications, from 1988 the EMR method has been used for 436 lesions as a radical treatment for gastric adenomas (n=234) and well-differentiated adenocarcinomas (n=202). Of the 202 lesions, 14 lesions (6.9%) were diagnosed histopathologically as invasive (sm) cancers. Endoscopic follow-up was made in four patients but no residual lesion was demonstrated. Seven patients with sm1~2 cancers underwent surgical operation after EMR. In six cases with positive submucosal invasion, cancer cells were not found in surgical specimens. However, remains of cancer cells were found in mucosa in only one case. In these days, submucosal invasion of carcinomas has been divided into three degrees according to the grade of invasion of EMR treatment, the invasion depth: sm1, sm2 and sm3. From the standpoint of EMR treatment, invasion depth sm1 should be properly defined as a depth unassociated with lymph node metastasis. For differentiated adenocarcinoma, a range 200~400 μm from the lowest limit of the muscularis mucosae corresponded to the above mentioned sm1. However, we cannot diagnose precisely the degree of submucosal invasion prior to EMR, so we don't think that EMR is an effective cure for clinically detectable invasive cancers.


Copyright © 1997, 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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