Early gastric cancer: endoscopic mucosal resection

In Japan, endoscopic mucosal resection (EMR) is now accepted as a treatment option for cases of early gastric cancer (EGC) with minimum probability of associated lymph node metastasis. In National Cancer Center Hospital (NCCH), EMR is currently applied to patients with early cancers up to 30 mm diameter that were of intestinal type, and were superficially elevated and/or depressed (Type I, IIa and IIc) but without ulceration or definite signs of submucosal invasion. Four hundred seventy nine lesions of EGC in 449 patients were treated by EMR from 1987 through 1998. Submucosal invasion was found on subsequent pathologic examination in 74 lesions, and surgery was recommended. Sixty nine percent of intramucosal cancer was resected with a clear margin, which was therefore judged to be a "complete resection". Local recurrence in the stomach occurred in 2% (5 lesions) with complete resection and in 17% (18 lesions) without complete resection treated conservatively or endoscopically, and all were subsequently treated with curative intent. There were no gastric cancer-related deaths for a median follow-up period of 38 months (3-120 months). Bleeding and perforation were two major complications in EMR, but there were no treatment-related deaths. We believe that EMR allows us to perform less-invasive treatment without sacrificing the possibility of cure. We hope to promote its use around the world.