[Endoscopic mucosal resection for early gastric cancer]

Endoscopic therapy of gastric cancer has been mainly performed to early cancer of nonresectable cases, for example patients having severe complications, high aged group and patients refusing the operation. Recently, endoscopic mucosal resection (EMR) made it possible to do radical resection for small gastric cancer of resectable cases. 112 patients of small cancers which diagnosed as a cancer limited to the mucosa were investigated. Indication to perform EMR instead of surgery were determined pathologically as follows, 1. depressed type of cancer not accompanying with converging folds measuring 1 cm or less in size, 2. elevated type of cancer measuring 2 cm or less in size, 3. differentiated type of carcinomas. According to those indications, 112 cases with 129 lesions of early gastric cancer were resected. The incision procedure consisted in EMR using two-channel fiberscope, a large chating forceps and a snare, the tissue being ablated with a high frequency electrical current. 2-6 ml of phisocal saline was locally infused at the submucosal level before resection to do it safely.

Relationship between the prognosis and the histological distance from the edge of the specimen to the margin of the cancer were discussed. All of 81 cases having the distance more than 2 mm, it's called 'complete radical resection', were not recurrent, on the other hand 4 of 24 cases having the distance less than 2 mm, called 'incomplete radical resection', were recurrent at the site of resection and 12 of 24 cases obviously cancer spread to the edge of the specimen, called 'non-radical resection', were recognized the recurrence. conclusion, 1) On endoscopical resection for small gastric cancer, the distance more than 2 mm between the edge of the specimen and the margin of the cancer was necessary to get a complete radical resection. 2) Technical and mechanical problems still remained at the case of the cancer located in the angular region and gastric body.