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MULTICENTRE COLLABORATIVE PROSPECTIVE STUDY OF ENDOSCOPIC TREATMENT OF EARLY GASTRIC CANCER
Author(s) -
Ida Kazunori,
Nakazawa Saburo,
Yoshino Junji,
Hiki Yoshiki,
Akamatsu Taiji,
Asaki Shigeru,
Kurihara Minoru,
Shimao Hitoshi,
Tada Masahiro,
Misumi Atsunobu,
Kato Takahiro,
Niwa Hirohumi
Publication year - 2004
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2004.00400.x
Subject(s) - medicine , cancer , carcinoma , endoscopic mucosal resection , gastroenterology , lesion , gastric carcinoma , endoscopic treatment , surgery , endoscopy
Aims: The present study was conducted with the aims of elucidating the present state of endoscopic treatment, in particular endoscopic mucosal resection (EMR) of early gastric cancer, as well as any associated problems, and the prospects for further broadening of the indications for EMR. Subjects and methods: This study was begun in 1994 and completed in 2002. Lesions were classied into Group I, with macroscopic appearance of 0–I, IIa, IIb or IIc·U1(–), well‐ to moderately differentiated intramucosal carcinoma ≤ 20 mm in diameter, and Group II, with the same macroscopic appearance as Group I, intramucosal carcinoma either the same histological type with diameter 21–40 mm, or undifferentiated carcinoma ≤ 40 mm in diameter. Of the 412 subjects registered (Group I, 305 subjects; Group II, 107 subjects, including seven undifferentiated carcinoma cases), 258 were evaluated (Group I, 199 subjects; Group II, 59 subjects including seven undifferentiated carcinoma). Results: The overall complete excision rate for Group I was 71.9%, and was 82.4% for ≤ 10 mm, 67.2% for 11–15 mm, and 45.5% for 16–20 mm, thus declining with increasing lesion size. The long‐term results, including cases of additional treatment for residual cancer following the original EMR, showed that recurrence occurred in eight out of 199 cases (4.0%), in ve of whom local cure was achieved with endoscopic treatment, giving a nal local cure in 196 cases (98.5%). The overall complete excision rate for Group II differentiated carcinoma was 46.2%. With the inclusion of additional treatment, local cure was achieved with endoscopic treatment in 57 out of 59 cases (96.6%). The remaining two cases of recurrence underwent open surgery. Conclusion: Regardless of Group I or II classication, if the diagnosis of intramucosal cancer from the specimen resected at the initial EMR is histologically correct, then local cure can be achieved with endoscopic treatment, including cases of recurrence, with appropriate follow up and use of concomitant techniques such as piecemeal resection and coagulation therapy. The indications for endoscopic treatment can now reasonably be widened to include Group II lesions.