Indication and Limitation of Endoscopic Surgery of Early Gastric Cancer: An Analysis of 290 Early Cancers Operated on and 65 Early Cancers Treated Endoscopically

Atsunobu Misumi, Seiichi Mizumoto, Katsuki Misumi, Kazunori Harada, Hirofumi Kako, Ubehiko Honmyo, Kouichi Arima, Ichiro Yoshinaka, Masaomi Maeda, Michio Ogawa

Second Department of Surgery, Kumamoto University Medical School

To clarify the indications for and limitations of endoscopic surgery, particularly mucosal resection (EMR), for early gastric cancer, we reviewed 290 early cancer cases treated by operations and 65 treated by endoscopic surgery. We investigated lymph node metastasis and mode of invasion (continuous or incontinuous) in the former cases, and background factors and treatment results in the latter. EMR yielded the best results for curative endoscopic surgery for gastric cancer. All 122 resected gastric cancers that were confined to the mucosa were free of lymph node metastasis whereas 41 (24.4%) of 168 gastric cancers invading the submucosa metastasized to the lymph nodes, suggesting that surgical treatment is indicated when a specimen from EMR shows invasion of the submucosa. No lymph node metastasis occurred in cancers that were elevated grossly or well differentiated histologically and smaller than 2.0 cm in size, and those that were depressed or poorly differentiated and smaller than 1.0 cm. Among surgically resected cancers smaller than 2 cm, 12 (92.3%) of 13 lesions that were elevated or well differentiated showed incontinuous invasions within 1 mm, and 13 (92.9%) of 14 lesions that were depressed or poorly differentiated showed incontinuous invasion within 2 mm, suggesting that endoscopic surgery requires 2 mm of cancer clearance to cure the cancer. In conclusion, EMR is the best procedure for minute and small gastric cancers less than 1.0 cm, producing as good results as surgical treatment.

Key words
radical endoscopic mucosal resection, indication of endoscopic surgery, early gastric cancer

Reprint requests
Atsunobu Misumi Second Department of Surgery, Kumamoto University Medical School
1-1-1 Honjo, Kumamoto, 860 JAPAN

Accepted
July 3, 1991

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