| [ Summary ] |
To clarify the indications for and limitations of endoscopic resection (EMR) of nodule aggregating tumors, i.e. en bloc or piecemeal resection, 186 lesions were analyzed clinicopathologically. These tumors consisted of adenomas, intramucosal carcinomas and carcinomas with sm1 invasions. The average size of adenomas and carcinomas was 18.0mm and 25.8mm, respectively. The average size of the tumors treated with an en bloc EMR and with piecemeal EMR was 16.4mm and 26.1mm, respectively. The pathologically positive rates of the cut ends was between 63.4% and 100%, when an en bloc EMR was performed on a tumor of 20 to 25mm in size and over 26mm in diameter, respectively. In tumors treated with piecemeal EMR, most cases showed the cut ends to be pathologically positive even when their diameters ranged from 10 to 15mm. Local recurrence was found in 11 (14.3%) of 77 pathologically cut positive end cases, during a follow-up examination. Surgery was performed in 3 out of 11recurrent cases. These results suggest that when tumor size is less than 20mm in diameter, an en bloc EMR could achieve complete removal with a pathologically free cut end. Although the skill of en-doscopists may enable them to treat large tumors(of more than 20mm in size) with piecemeal EMR, they should be cautioned to take adequate safety measures. More important thing for endoscopists is not to hesitate to put patients in the hands of surgeons who can manage to treat such tumors with minimal invasive surgery, which has made remarkable progress in recent years. |