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Sa1665 The Incidence of Lymph Node Metastasis in Cases of Early Gastric Signet Ring Cell Carcinoma is As Low As Early Gastric Differentiated Adenocarcinoma
Abstracts
are that the possibility of lymphatic and venous invasion is high in diffuse type and lymph node dissection is impossible in ESD. In Japan, we define diffuse type T1a cancer smaller than 20mm in diameter without ulceration and lymphatic and venous invasion as the expanded indication for ESD and we have performed ESD for such lesions with careful supervision. We examined the validity of ESD for the expanded indications by verifying the lesions which performed operation or ESD in our hospital. Materials and Methods: Consecutive 161 patients (165 lesions) with diffuse type early gastric cancer were enrolled in this study between January 2005 and October 2011. (1) Among 138 patients (142 lesions) which underwent operation (92 males and 46 females; mean age 59.3; 73 T1a and 69 T1b lesions), we divided into subgroups by the tumor invasion depth (T1a or T1b), the diameter of tumor (⬎20mm or ⬉20mm) and the presence of ulceration. We investigated the clinicopathological features among the subgroups. (2) Among 23 patients (23 lesions) which performed ESD (16 males and 7 females; mean age 68.0; 16 T1a and 7 T1b lesions), we examined (a) the treatment results of ESD and (b) postoperative progress. Results: (1) Among the patients receiving surgery, the proportions of lymphatic or venous invasion and lymph node metastasis were 29.6% (42/142) and 16.2% (23/142), respectively. T1a lesions without ulceration have no lymph node metastasis irrespective of tumor size (0/27). In overall T1b lesions, the proportion of lymph node metastasis was 26.1%. The lesions that lymph node metastasis were positive were included in all T1b subgroups. (2) (a) Among 23 lesions, the expanded indications were 11 lesions. The average diameter of tumors and resection specimens were 24.1mm and 49.7mm, respectively. Complete resection with negative margin was 91.3 % (21/23). The average duration of ESD was 117 min. There were no perforation and bleeding after ESD. (b) In expanded indications, four of eight patients whom we could follow up had no recurrence (median observation period; 34.5 months). Although two patients underwent additional operation after ESD, there were no residual tumor and lymph node metastasis. One patient underwent operation for metachronous gastric cancer and one patient died of other disease. Conclusion: In examination of surgical specimen, there was no lymph node metastasis in expanded indications. In investigation of the results of ESD and postoperative progress, we could perform ESD for expanded indications safely and there was no recurrence. We conclude that the expanded indication can be completely cured by ESD.
Sa1665 The Incidence of Lymph Node Metastasis in Cases of Early Gastric Signet Ring Cell Carcinoma is As Low As Early Gastric Differentiated Adenocarcinoma Sang Heon Lee*, Sam Ryong Jee, Ji Hyun Kim, Kyung Sun Ok, Jung Sik Choi, Sang Young Seol Internal Medicine, Inje University Medical College, Busan, Republic of Korea Background: With the increased detection of early gastric cancer (EGC) and the technical advances of endoscopic submucosal dissection (ESD), the indications for ESD have been extended to those patients with signet ring cell carcinoma (SRCC). We compared the endoscopic and clinicopathologic characteristics of early gastric SRCC with those of non-signet ring cell carcinoma (NSRCC). We investigated the possibility of performing endoscopic resection for early SRCC. Methods: We retrospectively investigated the medical records of 114 patients who were diagnosed with early SRCC by the pathologic findings after gastrectomy with lymph node dissection from January 2003 to September 2011. We analyzed the clinical, endoscopic and histopathological characteristics, as compared with those of the patients with early NSRCC (n⫽582). We also analyzed the three subgroups of cell differentiation, as compared with that of early SRCC. Results: The patients with EGC with a signet ring cell histology showed a higher frequency of females, younger age, and predominant mid-third location. SRCC had lower rate of submucosal invasion and lymph node metastasis than NSRCC. In addition, rates of submucosal invasion and lymph node metastasis were not statistical different between SRCC and well differentiated adenocarcinoma. There was no lymph node metastasis when it was an intramucosal cancer of less than 20mm and without lymphovascular invasion. Conclusion: Early gastric SRCC showed significantly lower incidence of submucosal invasion and lymph node metastasis than NSRCC. The clinical results were not inferior to those of well-differentiated adenocarcinoma group. Intramucosal gastric SRCC of less than 20mm and without lymphovascular invasion can be considered as a candidate for ESD.
Sa1666 Can Perforation in Gastric Endoscopic Submucosal Dissection be Dealt With Using Conservative Medical Treatment? Jun Nakamura*1, Takuto Hikichi2, Masaki Sato1, Tadayuki Takagi1, Tsunehiko Ikeda1, Ko Watanabe1, Atsushi Irisawa3, Katsutoshi Obara2, Hiromasa Ohira1 1 Gastroenterology and Rhumatology, Fukushima Medical University School of Medicine, Fukushima, Japan; 2Dpertment of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; 3 Gastroenterology, Fukushima Medical University Aizu Medical center, Fukushima, Japan Background: This study examines characteristics of perforation in gastric Endoscopic submucosal dissection (ESD) to clarify appropriate treatment policies. Methods: We conducted gastric ESD between July 2003 and July 2011 in 536 cases for 587 lesions. In 15 cases who were occurred perforation during and after ESD were examined the patient background, the time of perforation detection, treatment, and progression. For perforation found during ESD, if X-ray detected free air immediately after the operation, it was defined as perforation; if X-ray or CT detected free air on the next day, it was defined as delayed perforation. Results: The 15 cases included 13 men and 2 women, with mean age of 75.8 (61-81). Regarding lesion location, 8 cases were related to the upper body, 5 cases to the middle body, and 2 cases to the lower body. The mean excised length was 38.9mm (25-70). In terms of invasion depth, submucosal layer was found in 2 cases and mucosal layer in 13 cases. One case showed complication of an ulcer scar. Main medications included hypotensors (7 cases), antiplatelet drugs (6 cases), anticoagulant drugs (one case), antidiabetic drugs (3 cases), and steroids (one case). Regarding discovery time, the perforation was
AB238 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org
are that the possibility of lymphatic and venous invasion is high in diffuse type and lymph node dissection is impossible in ESD. In Japan, we define diffuse type T1a cancer smaller than 20mm in diameter without ulceration and lymphatic and venous invasion as the expanded indication for ESD and we have performed ESD for such lesions with careful supervision. We examined the validity of ESD for the expanded indications by verifying the lesions which performed operation or ESD in our hospital. Materials and Methods: Consecutive 161 patients (165 lesions) with diffuse type early gastric cancer were enrolled in this study between January 2005 and October 2011. (1) Among 138 patients (142 lesions) which underwent operation (92 males and 46 females; mean age 59.3; 73 T1a and 69 T1b lesions), we divided into subgroups by the tumor invasion depth (T1a or T1b), the diameter of tumor (⬎20mm or ⬉20mm) and the presence of ulceration. We investigated the clinicopathological features among the subgroups. (2) Among 23 patients (23 lesions) which performed ESD (16 males and 7 females; mean age 68.0; 16 T1a and 7 T1b lesions), we examined (a) the treatment results of ESD and (b) postoperative progress. Results: (1) Among the patients receiving surgery, the proportions of lymphatic or venous invasion and lymph node metastasis were 29.6% (42/142) and 16.2% (23/142), respectively. T1a lesions without ulceration have no lymph node metastasis irrespective of tumor size (0/27). In overall T1b lesions, the proportion of lymph node metastasis was 26.1%. The lesions that lymph node metastasis were positive were included in all T1b subgroups. (2) (a) Among 23 lesions, the expanded indications were 11 lesions. The average diameter of tumors and resection specimens were 24.1mm and 49.7mm, respectively. Complete resection with negative margin was 91.3 % (21/23). The average duration of ESD was 117 min. There were no perforation and bleeding after ESD. (b) In expanded indications, four of eight patients whom we could follow up had no recurrence (median observation period; 34.5 months). Although two patients underwent additional operation after ESD, there were no residual tumor and lymph node metastasis. One patient underwent operation for metachronous gastric cancer and one patient died of other disease. Conclusion: In examination of surgical specimen, there was no lymph node metastasis in expanded indications. In investigation of the results of ESD and postoperative progress, we could perform ESD for expanded indications safely and there was no recurrence. We conclude that the expanded indication can be completely cured by ESD.
Sa1665 The Incidence of Lymph Node Metastasis in Cases of Early Gastric Signet Ring Cell Carcinoma is As Low As Early Gastric Differentiated Adenocarcinoma Sang Heon Lee*, Sam Ryong Jee, Ji Hyun Kim, Kyung Sun Ok, Jung Sik Choi, Sang Young Seol Internal Medicine, Inje University Medical College, Busan, Republic of Korea Background: With the increased detection of early gastric cancer (EGC) and the technical advances of endoscopic submucosal dissection (ESD), the indications for ESD have been extended to those patients with signet ring cell carcinoma (SRCC). We compared the endoscopic and clinicopathologic characteristics of early gastric SRCC with those of non-signet ring cell carcinoma (NSRCC). We investigated the possibility of performing endoscopic resection for early SRCC. Methods: We retrospectively investigated the medical records of 114 patients who were diagnosed with early SRCC by the pathologic findings after gastrectomy with lymph node dissection from January 2003 to September 2011. We analyzed the clinical, endoscopic and histopathological characteristics, as compared with those of the patients with early NSRCC (n⫽582). We also analyzed the three subgroups of cell differentiation, as compared with that of early SRCC. Results: The patients with EGC with a signet ring cell histology showed a higher frequency of females, younger age, and predominant mid-third location. SRCC had lower rate of submucosal invasion and lymph node metastasis than NSRCC. In addition, rates of submucosal invasion and lymph node metastasis were not statistical different between SRCC and well differentiated adenocarcinoma. There was no lymph node metastasis when it was an intramucosal cancer of less than 20mm and without lymphovascular invasion. Conclusion: Early gastric SRCC showed significantly lower incidence of submucosal invasion and lymph node metastasis than NSRCC. The clinical results were not inferior to those of well-differentiated adenocarcinoma group. Intramucosal gastric SRCC of less than 20mm and without lymphovascular invasion can be considered as a candidate for ESD.
Sa1666 Can Perforation in Gastric Endoscopic Submucosal Dissection be Dealt With Using Conservative Medical Treatment? Jun Nakamura*1, Takuto Hikichi2, Masaki Sato1, Tadayuki Takagi1, Tsunehiko Ikeda1, Ko Watanabe1, Atsushi Irisawa3, Katsutoshi Obara2, Hiromasa Ohira1 1 Gastroenterology and Rhumatology, Fukushima Medical University School of Medicine, Fukushima, Japan; 2Dpertment of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; 3 Gastroenterology, Fukushima Medical University Aizu Medical center, Fukushima, Japan Background: This study examines characteristics of perforation in gastric Endoscopic submucosal dissection (ESD) to clarify appropriate treatment policies. Methods: We conducted gastric ESD between July 2003 and July 2011 in 536 cases for 587 lesions. In 15 cases who were occurred perforation during and after ESD were examined the patient background, the time of perforation detection, treatment, and progression. For perforation found during ESD, if X-ray detected free air immediately after the operation, it was defined as perforation; if X-ray or CT detected free air on the next day, it was defined as delayed perforation. Results: The 15 cases included 13 men and 2 women, with mean age of 75.8 (61-81). Regarding lesion location, 8 cases were related to the upper body, 5 cases to the middle body, and 2 cases to the lower body. The mean excised length was 38.9mm (25-70). In terms of invasion depth, submucosal layer was found in 2 cases and mucosal layer in 13 cases. One case showed complication of an ulcer scar. Main medications included hypotensors (7 cases), antiplatelet drugs (6 cases), anticoagulant drugs (one case), antidiabetic drugs (3 cases), and steroids (one case). Regarding discovery time, the perforation was
AB238 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org