Local Excision for Early Gastric Cancers

Mitsuru Sasako, Taira Kinoshita, Keiichi Maruyama, Kenzoh Okabayashi, Hisao Tajiri, Shigeaki Yoshida, Hajime Yamaguchi, Daizoh Saitoh, Yanao Oguro, Tsutomu Ishikawa, Hiroto Matsue, Tatsuya Yamada

Department of Surgical Oncology, Medical Oncology and Diagnostic Radiology, National Cancer Center Hospital

Complete local excision of early gastric cancers is expected to give as good results as radical surgery if we can determine the lesions having no lymph node metastases. 1440 cases of single early gastric cancer resected in National Cancer Center Hospital (NCCH) from 1962 to 1985 were analysed: IIb cancers of any size, IIc less than 2.1 cm in diameter without ulcerative change, and IIa less than 2.1 cm in diameter had no lymph node metastases. Based on this data, a prospective trial of local excision was started in NCCH in April 1988. Considering errors for safety, IIa cancers less than 1.6 cm, gastritis type lesions less than 1.6 cm and focal cancers in adenoma were consiedered indications for local excision. Endoscopic local excision is prefered so far as it is possible. The resected specimens are to be examined histologically. If a lesion limited to the mucosal layer is resected completely and has no vessel involvement, the patient will be folowed up intensively. If the cut margin is involved by cancer in the mucosal layer, additional interventional wider local excision is made. In cases where submucosal invasion or vessel involvement is seen, radical gastrectomy is added. Eleven patients were eligible for this treatment system. Eight of them were treated successfully by local excision, and the rest underwent additional intervention. All patients are now disease free and are being followed up intensively. This treatment system enables us to perform local therapy as a curative treatment without reducing the possibility of a cure.

Key words
local excision of early gastric cancer, endoscopic excision of early gastric cancer, strip biopsy, indication of local treatment of gastric cancer

Reprint requests
Mitsuru Sasako Gastric Division, Department of Surgical Oncology, National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, Tokyo, 104 JAPAN

Accepted
February 14, 1990

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