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A Clinicopathological Study on Endoscopic Treatment of Gastric Carcinoma by Laser Tsai C-H. 1,2 , H. Akabane 1 , K. Nakamura 1 , A. Nakahara 2 , H. Fukutomi 2 1Department of Pathology, University of Tsukuba 2Department of Gastroenterology, Faculty of Medicine, University of Tsukuba pp.873-883
Published Date 1984/8/25
DOI https://doi.org/10.11477/mf.1403109571
  • Abstract
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 Recently, endoscopic treatment of gastric carcinoma by laser has been applied to patients having early carcinoma whose gastrectomy is not done by some reasons. During the past four years,28 gastric carcinomas in early phase have been endoscopically treated by laser at our hospital (Table 1).

 In this study, these 28 lesions were examined histopathologically in order to establish indicative condition of carcinoma for laser therapy as well as to find the cause of failure of laser therapy in these lesions.

 Four out of twenty eight lesions were resected after laser therapy (Nos. 25, 26, 27, 28 in Table 1), and the other twenty four have been followed up endoscopically after laser therapy. Eighteen lesions have not been observed to be recurrent after five to fifty two months (twenty five months on the average) of trace. In this investigation, the results show that macroscopic type, depth infiltration and histological type of tumor play important role on the recurrence rate of laser therapy. The recurrence rate is minimal in Types Ⅰ and Ⅱa, followed by Type Ⅱc. Recurrence rates of intramucosal carcinoma and differentiated carcinoma are quite lower than those of carcinoma infiltrating submucosa and undifferentiated carcinoma, respectively. The main causes of failure of laser therapy are thought to be due to insufficient laser effect on the deep cancerous tissue and incomplete irradiation which causes leaving cancerous tissue in the irradiation field.

 It may be concluded that the endoscopic coagulation therapy by laser is expected to have high cure rate in intramucosal carcinoma smaller than 2 cm in diameter except the undifferentiated carcinoma arising from the fundic gland mucosa where latent linitis plastica type carcinoma sometimes grows and vertical invasive rate is higher than the other parts. Furthermore, when the biopsy specimen shows muconodular, medullary or adenosquamous carcinoma pattern, laser therapy is not indicated because they strongly suggest advanced carcinoma. Otherwise, the accurate diagnosis of boundary and depth infiltration of carcinoma before irradiation and the even irradiation over all of the cancer surface without leaving cancerous tissue are the most important factors for successful treatment.


Copyright © 1984, 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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