Abstract
Purpose
The aim of this study was to pathologically investigate the developmental pattern of undifferentiated mucosal gastric cancer and to determine safe surgical margins for curative resection by endoscopic resection.
Results
Intramucosal cancer spread, or the width of the proliferative zone, was pathologically investigated in 47 cases of undifferentiated mucosal gastric cancer of size 20 mm or smaller without ulceration (scars). The 47 cases comprised 40 IIc and 7 IIb cases. The IIc cases consisted of 5 (12.5%) of intermediate-layer type (cancer localized at the intermediate layer of the mucosa), 31 (77.5%) of superficial type, and 4 of whole-layer type (10%). The IIb cases consisted of six of intermediate-layer type (85.7%) and one of superficial type (14.3%). The width of the proliferative zone in the 40 IIc cases ranged from 0 to 2,390 μm (average 605.5 μm). There was no significant correlation between width of proliferative zone and background mucosa. With regard to lesion size, average width was 243.6 μm in cases with longest diameter ≤5 mm, while it was significantly larger (617.1 μm) in cases with diameter >5 mm.
Conclusions
In endoscopic treatment of undifferentiated mucosal gastric cancer of size 20 mm or smaller without ulceration (scars), the lateral safety margin should be 3 mm or more.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Japanese Gastric Cancer Association, ed. Guidelines for Gastric Cancer Treatment (for doctors). 2nd ed. Tokyo: Kanahara Syuppan; 2004. (in Japanese).
Hamada T, Yoshimine T, Kubota H, et al. Endoscopic resection of early gastric cancer: criteria for evaluating treatment outcomes and problems in relation with prognosis. Stomach Intest. 1991;26:255–265. (in Japanese).
Misumi A, Kimoto S, Harada K, et al. Mucosal resection for gastric cancer. Surgery. 1992;54:1304–1314. (in Japanese).
Ninomiya Y, Yanagisawa A, Kato Y, et al. Unresectable intramucosal spread of diffuse-type mucosal carcinoma of less than 20 mm in size. Endoscopy. 2000;32:604–608. doi:10.1055/s-2000-16506.
Nishigami T, Kojima T, Hori K, et al. Pathological diagnosis of expansion of mucosal gastric cancer. Stomach Intest. 2001;36(10):1257–1264. (in Japanese).
Yao T, Fujiwara T, Watanabe H, et al. Endoscopic diagnosis of expansion of gastric cancer. Stomach Intest. 1972;7:725–738. (in Japanese).
Yao T, Mizoguchi M, Okada M, et al. Endoscopic findings of early gastric cancer and comparison in resected specimens. Stomach Intest. 1988;23:55–66. (in Japanese).
Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–225. doi:10.1007/PL00011720.
Muto M, Hamamoto Y, Ono H, et al. EMR of early gastric cancer. Possibilities of expansion of indications for EMR of undifferentiated mucosal gastric cancer. Rinsho Syoukaki Naika. 2001;16:1651–1656. (in Japanese).
Hamada T, Kondo K, Itagaki Y, et al. Outcomes of endoscopic resection of minute undifferentiated gastric cancer. Indications based on cancer size. Stomach Intest. 1995;30:1279–1287. (in Japanese).
Nakano K, Yanagisawa A, Utsude K, et al. Limitations of indications for endoscopic mucosal resection (EMR) of undifferentiated gastric cancer. Pathological view. Stomach Intest. 1995;30:1289–1293. (in Japanese).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sawada, S., Fujisaki, J., Yamamoto, N. et al. Expansion of Indications for Endoscopic Treatment of Undifferentiated Mucosal Gastric Cancer: Analysis of Intramucosal Spread in Resected Specimens. Dig Dis Sci 55, 1376–1380 (2010). https://doi.org/10.1007/s10620-009-0883-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-009-0883-4