WORKSHOP

IL CANCRO DELLO STOMACO

CLINICAL EVALUATION OF ENDOSCOPIC THERAPY 　FOR EARLY  GASTRIC  CANCER

Cancer Institute Hospital, Tokyo JAPAN

Hiroshi Takahashi, MD, PhD

Messina
15 giugno 2001

AIM: 
The clinical course of early gastric cancers treated by endoscopic resection and Nd-YAG laser was evaluated.
PATIENTS AND METHODS: 
Our study included 227 patients: 178 patients treated by endoscopic resection alone, 29 　who  underwent  surgery  after endoscopic resection, and 20 in whom endoscopic resection was combined with the use of Nd-YAG laser.
RESULTS:  

116 patients had elevated type early gastric cancer.  Concerning the size of mucosal lesions, in 59 patients they  measured 10 mm or less, in 45 patients 11 to 20 mm, and  in 16 patients more than 21 mm.  Among  these, "en bloc" resection was possible in 63%, 35% and 31% respectively.  106 patients  had  depressed type early gastric cancer.  "En bloc" resection was conducted in 50 of 80 patients with mucosal cancer measuring 10 mm or less, and piecemeal resection was carried out in 30 patients.  "En bloc" resection was possible in 8 of the 26 patients with cancer measuring 11-20 mm.
Residual cancer was noted in 11 of 29 patients in whom additional surgery was conducted. Recurrence occurred in 5 patients who underwent endoscopic resection plus Nd-YAG adjuvant therapy. Patients with multiple lesions who had endoscopic treatment were reviewed.  16 patients had multiple cancers.
CONCLUSION:  
Local recurrence and distant metastasis did not occur in patients with early gastric cancer when "en bloc" endoscopic resection was undertaken with a sufficient distance between the lesions and the cut stump.
Additional surgery or close observation seemed to be necessary after
piecemeal resection due to the high probability of residual cancer.  The
multiple cancers were detected in 8%, indicating the need for close
observation before and after treatment.

A cura di: Unità di Chirurgia Endoscopica - Ospedale Piemonte - Messina

© 2001