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Successful treatment of an undifferentiated early stage gastric cancer by combined en bloc EMR and laparoscopic regional lymphadenectomy

2003; Elsevier BV; Volume: 57; Issue: 7 Linguagem: Inglês

10.1016/s0016-5107(03)70056-x

1097-6779

Nobutsugu Abe, Toshiyuki Mori, Yumi Izumisato, Hideo Sasaki, Hisayo Ueki, Tadahiko Masaki, Masanobu Nakashima, Masanori Sugiyama, Yutaka Atomi,

Gastrointestinal Tumor Research and Treatment

EMR is widely used to treat early stage gastric cancer (EGC). 1 Ono H Kondo H Gotoda T Shirao K Yamaguchi H Saito D et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001; 48: 225-229 Crossref PubMed Scopus (1358) Google Scholar The criteria for EMR generally accepted in Japan are a differentiated mucosal cancer smaller than 2 cm without ulceration; such cancers rarely metastasize to lymph nodes. However, EMR of undifferentiated EGC, even if limited to the mucosa, is not recommended because of the higher probability of its metastasis to lymph nodes (4.2%) compared with differentiated EGC (0.4%), 2 Gotoda K Yanagisawa A Sasako M Ono H Nakanishi Y Simoda T et al. Incidence of lymph node metastasis from early gastric cancer. The estimation using a large number of cases in two large centers. Gastric Cancer. 2000; 3: 219-225 Crossref PubMed Scopus (1460) Google Scholar as well as its diffuse and ill-defined superficial growth pattern. Thus, gastrectomy with regional lymphadenectomy has generally been considered the treatment of choice for undifferentiated EGC. However, in almost all (96%) surgical cases of undifferentiated EGC, lymph node metastasis is not present. Inasmuch as there is no diagnostic modality, other than histopathologic evaluation, for assessment of lymph node involvement, lymphadenectomy is required for assessment of lymph nodal status. If EMR is performed for undifferentiated EGC, local treatment by removal of a large area together with the tumor and additional surgical lymphadenectomy for histopathologic assessment may be an alternative treatment method. However, combined endoscopic management and surgical (open or laparoscopic) lymphadenectomy without gastrectomy in patients with EGC has not been described. A case is presented of a large undifferentiated EGC successfully treated by en bloc EMR of the entire lesion as single fragment with the newly developed insulation-tipped diathermic knife (IT knife) 1 Ono H Kondo H Gotoda T Shirao K Yamaguchi H Saito D et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001; 48: 225-229 Crossref PubMed Scopus (1358) Google Scholar , 3 Hosokawa K Yoshida S Recent advances in endoscopic mucosal resection for early gastric cancer [in Japanese with English abstract]. Jpn J Cancer Chemother. 1998; 25: 476-483 PubMed Google Scholar , 4 Gotoda T Kondo H Ono H Saito Y Yamaguchi H Saito D et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal lesions: report of two cases. Gastrointest Endosc. 1999; 50: 560-563 Abstract Full Text Full Text PDF PubMed Scopus (375) Google Scholar , 5 Kondo H Gotoda T Ono H Oda I Yamaguchi H Saito D et al. Early gastric cancer: endoscopic mucosal resection. Ann Ital Chir. 2001; 72: 27-31 PubMed Google Scholar , 6 Ohkuwa M Hosokawa K Boku N Ohtu A Tajiri H Yoshida H. New endoscopic treatment for intramucosal gastric tumors using an insulation-tip diathermic knife. Endoscopy. 2001; 33: 221-226 Crossref PubMed Scopus (370) Google Scholar , 7 Miyamoto S Muto M Hamamoto Y Boku N Ohtu A Baba S et al. A new technique for endoscopic mucosal resection with an insulation-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc. 2002; 55: 576-581 Abstract Full Text Full Text PDF PubMed Scopus (247) Google Scholar and laparoscopic regional lymphadenectomy.