| Theme |
Expansion of Indications for Endoscopic Mucosal Resection of Early Gastrointinal Cancer |
| Title |
Endoscopic Mucosal Resection for Diffuse-type Mucosal Gastric Cancer |
| Author |
Manabu Muto |
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East |
| Author |
Yasuo Hamamoto |
Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East |
| Author |
Hiroyuki Ono |
Division of Endoscopy, National Cancer Center Hospital |
| Author |
Takuji Gotoda |
Division of Endoscopy, National Cancer Center Hospital |
| Author |
Toshihiko Doi |
Division of Internal Medicine, National Shikoku Cancer Center |
| Author |
Hisao Tajiri |
Department of Endoscopy, The Jikei University School of Medicine |
| [ Summary ] |
Although endoscopic mucosal resection (EMR) for intestinal-type mucosal gastric cancer (MGC) has become generally accepted, the indications for EMR for diffuse-type MGC are controversial. In regard to cure rates associated with EMR for diffuse-type MGC, we investigated risk factors for lymph node metastasis in 969 surgically resected lesions. Multivariate analysis, showed that tumor size over 2cm and the presence of histological ulceration, including scar formation, were independent risk factors for lymph node metastasis (odds ratio, 2.7 and 3.1, respectively). To perform EMR on diffuse-type MGC, we should pay special attention to the following; (1) correct detection of tumor positive margins, using endoscopy, (2) adequate cancer-negative margins of, at least 10mm, outside the macroscopic tumor positive margin, (3) en bloc resection, to obtain large specimens, and (4) histological assessment, to recommend additional treatment, such as surgical resection. To justify the indications for EMR for diffuse-type MGC, we should further investigate whether the disease-free survival rate is similar between those patients with diffuse-type MGC, treated with EMR, and those treated with surgery. |