Controversy Concerning the Cutoff Value for Depth of Submucosal Invasion after Endoscopic Mucosal Resection of Early Gastric Cancer

Cho, J. Y.; Kim, Y. S.; Jung, In Seop; Ryu, Chang Beom; Lee, M. S.; Shim, Chan-Sup; Jin, Si Young

doi:10.1055/s-2006-925160

Cited by 16 publications

(14 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This also comes from a concept of investigating the nature of gut as a full layer rather than a partial one after artificial stretching. Furthermore, simple one-step stretching attempted in the previously cited report 7 would not prove any correlation of the extent of stretching and subsequent thinning of submucosal layer.…”

Section: Introductionmentioning

confidence: 73%

“…Thickness of tissue may vary depending on the manual force given for stretching before tissue fixation, and not the whole layer but partial layer including mucosa and superficial submucosa are taken after EMR. 7 In our view, submucosal thickness still has reason to be evaluated as a component of intact thickness, although the tissue retrieved after EMR is partial rather than a full layer of gut. This premise originates from an idea to validate the previously suggested cut-off value of 500 um by the ECRG.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Stretching Causes Extensive Changes of Gastric Submucosa: Is It Acceptable to Define 500μm as the Safe Margin?

Park

Chun²,

Kwon³

et al. 2008

Gut Liver

View full text Add to dashboard Cite

Background/Aims: Endoscopic mucosal resection can cure early gastric cancer. The risk of lymphatic metastasis is related to the depth of submucosal invasion by the mucosal malignancy, with a resection depth of 500μm generally accepted as a safe cut-off. However, excessive thinning induced by stretching of the resected tissue sometimes preventing a precise diagnosis. We studied the effects of stretching on different layers and sites of gastric tissue. Methods: Porcine stomachs were cut into 2.0×2.0 cm pieces, and pieces from body were stretched to 2.5, 3.0, and 3.5 cm. Pieces from the cardia, body, and antrum were also stretched to 3.0 cm. The thickness of each layer was measured and analyzed statistically. Results: Whole gastric wall and submucosal layers showed gradual thinning, with stretching to 3.5 cm tearing the tissues and resulting in imperfect extension. The submucosa was thinner in body tissue than in cardia and antrum tissues. Stretching to 3.0 cm induced a consistent decrease in submucosal thickness (30-70%). The change in thickness varied widely between individual samples. Conclusions: A resection margin of 500μm might be insufficient for the complete removal of malignancy. Moreover, the thickness of the submucosal layer differs with the gastric site and between individuals. Future studies are needed to confirm the findings in human tissue.

show abstract

Section: Introductionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 97%

Stretching Causes Extensive Changes of Gastric Submucosa: Is It Acceptable to Define 500μm as the Safe Margin?

Park

Chun²,

Kwon³

et al. 2008

Gut Liver

View full text Add to dashboard Cite

show abstract

“…A final limitation is particularly relevant to submucosal cancers regarding the measurement of depth of invasion. Some studies have reported that depth of invasion might be influenced by the amount of desmoplasia and could decrease as the specimen is stretched29, 30. Song and colleagues31 found microscopic margins that were negative after EMR or ESD, but scattered residual cancer cells near the EMR or ESD site after surgery, in two of ten patients with submucosal cancer.…”

Section: Discussionmentioning

confidence: 99%

Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines

Jee

Hwang

Rao

et al. 2009

British Journal of Surgery

View full text Add to dashboard Cite

Extending the indications for EMR and ESD according to the Japanese Gastric Cancer Association guidelines carries an increased risk of lymph node metastasis. For cancers meeting these criteria, treatment by gastric resection with lymph node dissection should still be considered. A well differentiated mucosal cancer of any size without ulceration may be considered as an extended indication for EMR or ESD.

show abstract

“…The accuracy of preoperative diagnosis of nodal metastases in EGC using computed tomography varies widely by methodology [29,30]. In this study, the accuracy of preoperative diagnosis was relatively low, and we did not know whether nodal metastases were present until we performed surgery with lymphadenectomy.…”

Section: Discussionmentioning

confidence: 89%

Clinicopathological characteristics and treatment strategies in early gastric cancer: a retrospective cohort study

Ito

Inoue

Ikeda

et al. 2011

J Exp Clin Cancer Res

View full text Add to dashboard Cite

BackgroundBoth endoscopic and surgical approaches are employed in the treatment of early gastric cancer (EGC). The aim of this study was to establish appropriate treatment strategies for early gastric cancer.MethodsWe retrospectively examined clinicopathological data of EGC patients who had undergone surgery.ResultsA total of 327 patients (204 males and 123 females, mean age 63.2 years) were eligible for inclusion in the study. The median follow-up period was 31 months. Of 161 mucosal (pT1a) tumors, 87 were mainly undifferentiated and 110 had an undifferentiated component. Four patients with pT1a tumors had lymph node metastases; all these tumors were signet-ring cell carcinomas and were macroscopic type 0-IIc with ulceration, and only one of them had lymphatic invasion. Among patients with submucosal tumors, four of 43 patients with pT1b1 tumors and 37 of 123 patients with pT1b2 tumors had nodal metastases. Lymph node metastases were significantly higher in mixed undifferentiated type group than differentiated type group for both groups, pT1a-pT1b1 (p = 0.0251) and pT1b2 (p = 0.0430) subgroups. Only four of 45 patients with nodal metastases were diagnosed preoperatively by computed tomography (sensitivity 8.9%, specificity 96.2%). Nine patients with pT1b tumors had recurrence after surgery, and died. The sites of initial recurrence were liver, bone, peritoneum, distant nodes, and the surgical anastomosis.ConclusionsThe incidence of nodal metastases was approximately 5% in undifferentiated type mucosal (pT1a) tumors, and higher in submucosal (pT1b) tumors. The sensitivity of preoperative diagnosis of nodal metastases in EGC using computed tomography was relatively low in this study. Therefore at present surgery with adequate lymphadenectomy should be performed as curative treatment for undifferentiated type EGC.

show abstract

Controversy Concerning the Cutoff Value for Depth of Submucosal Invasion after Endoscopic Mucosal Resection of Early Gastric Cancer

Cited by 16 publications

References 0 publications

Stretching Causes Extensive Changes of Gastric Submucosa: Is It Acceptable to Define 500μm as the Safe Margin?

Stretching Causes Extensive Changes of Gastric Submucosa: Is It Acceptable to Define 500μm as the Safe Margin?

Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines

Clinicopathological characteristics and treatment strategies in early gastric cancer: a retrospective cohort study

Contact Info

Product

Resources

About