[Endoscopic mucosal resection (EMR) for early gastric cancer]

The treatment of early gastric cancer using an endoscopy, namely, endoscopic mucosal resection (EMR), has been employed in the world, especially in Japan from the beginning of 1980s. It has the advantage of enabling histopathological exploration of the resected specimen. This study involved of patients with solitary early gastric cancer who underwent a radical operation at the department of surgery, School of Medicine, Kitasato University. They selected from a retrospective study of the presence of lymph node metastasis based on histopathological findings. It was found that the early gastric cancer with negative lymph node appeared as an elevated tumor with the diameter of 2.5 cm or less; or concave tumor with the diameter of 2.0 cm or less and without concomitant ulcer in the lesion. Moreover, histologically differentiated adenocarcinoma and the invasion depth of m were desirable conditions for EMR. The above mentioned conditions were defined as the indications for EMR in a broad sense. This study redefined the size of a tumor that could be completely removed by one EMR. It has become clear that, based on our experience, the conditions should be strictly revised as follows; elevated tumors with the diameter of 2.0 cm or less and concave tumors with the diameter of 1.0 cm or less (absolute indications). If EMR is first selected for early gastric cancers under these strict conditions, it would promise the same favorable long-term survival rate as we experienced.