Endoscopic Mucosal Resection Specimens Research Articles

Local recurrence of colorectal tumors after endoscopic mucosal resection

We evaluated intramucosal local recurrences of 114 colorectal tumors which were removed by endoscopic mucosal resection (EMR). Removals of all these lesions were judged as successful by endoscopic absence of residual tumor immediately after EMR. The presence of residual tumor was determined by histologic and stereomicroscopic examinations in the lateral margin of resected specimen. There was no evidence of intramucosal local recurrence in 91 lesions with negative margin. However, intramucosal local recurrence occurred in 3 of 23 lesions (13%) with positive margin. Consequently endoscopic follow-up is mandatory in patients with lateral margin positive for tumor tissue in the EMR specimen.

A Clinicopathological Study on Surgically Resected Stomachs in Patients with Preceding Endoscopic Mucosal Resection for Early Gastric Cancer

We performed a clinicopathological study on surgical gastrectomy specimens in 19 patients who were operated on after endoscopic mucosal resection (EMR) which had been performed in an attempt to attain a radical cure of early gastric cancer. The surgical specimens were scrutinized for the purpose of evaluating the preceding EMR. The indications for surgical resection were extension of cancerous tissue to the mucosal stump or submucosal invasion in the EMR specimens, and residual cancer confirmed by follow‐up biopsy. Cancerous tissue was noted at the mucosal stump in the EMR specimen in 14 cases, among whom 12 (85. 7%) had remnant cancer in the mucosa of the resected stomach. In one case that had shown a cancer‐free distance of 1 mm at the mucosal stump of the EMR specimen, cancer was found in the mucosa of the resected stomach. Submucosal invasion was observed in the EMR specimen in 12 cases, among whom nine (75.0%) had nests of cancerous tissue left in the resected stomach. This study suggests that it is important in conducting radical EMR to ensure sufficient (2 mm or greater) cancer‐free mucosa at the margins. In other words, subsequent gastrectomy should be performed whenever cancer‐free margins of the EMR specimens are considered insufficient. It is also suggested that in cases with submucosal invasion, EMR inherently carries a high risk of incomplete excision leaving cancerous tissue and/or metastasis. More extensive surgery with lymph node dissection is indicated in such cases. (Dig Endosc 1996 ; 8 : 192‐198)