Estimation of subepithelial lateral extent in submucosal early gastric cancer

retrospective histological analysis

Osamu Goto, Ai Fujimoto, Masayuki Shimoda, Yasutoshi Ochiai, Tatsuo Matsuda, Hiroya Takeuchi, Hirofumi Kawakubo, Tadateru Maehata, Toshio Uraoka, Kaori Kameyama, Yuukou Kitagawa, Naohisa Yahagi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Endoscopic full-thickness resection (EFTR) is expected to make possible minimally invasive local resection of early gastric cancer (EGC). However, no consensus exists regarding how far an optimal safety margin should be set in determining the resection area by endoscopy. We aimed to investigate the optimal lateral margin of EGC which could be a candidate for EFTR by measuring the subepithelial extent (SE) of tumors.

Methods: In 60 surgically resected submucosal EGCs 4 cm or smaller, 595 prepared slides which showed lateral tumor borders both on the epithelial surface and on the subepithelial layer were assessed. The distance between the epithelial and the subepithelial tumor edge was measured under microscopic observation, followed by analyses of the relationship between the measured SE and the histological characteristics.

Results: The average and the median SE were 1.1 mm (standard deviation 1.8 mm) and 0.3 mm (range 0–12.3 mm), respectively. The 99th percentile was 8.8 mm. With regard to the histological type, the median SE was significantly greater in diffuse-type tumor than in intestinal-type tumor (0.9 mm vs 0 mm, p < 0.0001). With regard to the location of the subepithelilal tumor edge, the median SE was significantly greater in the submucosal layer than in the mucosal layer (2.6 mm vs 0.3 mm, p < 0.0001).

Conclusions: In most lesions, the SE was less than 1 cm. A safety margin may be set at 1 cm in EFTR of submucosal EGC.

Original languageEnglish
JournalGastric Cancer
DOIs
Publication statusAccepted/In press - 2014 Oct 21

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Stomach Neoplasms
Neoplasms
Safety
Endoscopy

Keywords

  • Early gastric cancer
  • Endoscopic full-thickness resection
  • Subepithelial extent

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Estimation of subepithelial lateral extent in submucosal early gastric cancer : retrospective histological analysis. / Goto, Osamu; Fujimoto, Ai; Shimoda, Masayuki; Ochiai, Yasutoshi; Matsuda, Tatsuo; Takeuchi, Hiroya; Kawakubo, Hirofumi; Maehata, Tadateru; Uraoka, Toshio; Kameyama, Kaori; Kitagawa, Yuukou; Yahagi, Naohisa.

In: Gastric Cancer, 21.10.2014.

Research output: Contribution to journalArticle

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abstract = "Background: Endoscopic full-thickness resection (EFTR) is expected to make possible minimally invasive local resection of early gastric cancer (EGC). However, no consensus exists regarding how far an optimal safety margin should be set in determining the resection area by endoscopy. We aimed to investigate the optimal lateral margin of EGC which could be a candidate for EFTR by measuring the subepithelial extent (SE) of tumors.Methods: In 60 surgically resected submucosal EGCs 4 cm or smaller, 595 prepared slides which showed lateral tumor borders both on the epithelial surface and on the subepithelial layer were assessed. The distance between the epithelial and the subepithelial tumor edge was measured under microscopic observation, followed by analyses of the relationship between the measured SE and the histological characteristics.Results: The average and the median SE were 1.1 mm (standard deviation 1.8 mm) and 0.3 mm (range 0–12.3 mm), respectively. The 99th percentile was 8.8 mm. With regard to the histological type, the median SE was significantly greater in diffuse-type tumor than in intestinal-type tumor (0.9 mm vs 0 mm, p < 0.0001). With regard to the location of the subepithelilal tumor edge, the median SE was significantly greater in the submucosal layer than in the mucosal layer (2.6 mm vs 0.3 mm, p < 0.0001).Conclusions: In most lesions, the SE was less than 1 cm. A safety margin may be set at 1 cm in EFTR of submucosal EGC.",
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author = "Osamu Goto and Ai Fujimoto and Masayuki Shimoda and Yasutoshi Ochiai and Tatsuo Matsuda and Hiroya Takeuchi and Hirofumi Kawakubo and Tadateru Maehata and Toshio Uraoka and Kaori Kameyama and Yuukou Kitagawa and Naohisa Yahagi",
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T1 - Estimation of subepithelial lateral extent in submucosal early gastric cancer

T2 - retrospective histological analysis

AU - Goto, Osamu

AU - Fujimoto, Ai

AU - Shimoda, Masayuki

AU - Ochiai, Yasutoshi

AU - Matsuda, Tatsuo

AU - Takeuchi, Hiroya

AU - Kawakubo, Hirofumi

AU - Maehata, Tadateru

AU - Uraoka, Toshio

AU - Kameyama, Kaori

AU - Kitagawa, Yuukou

AU - Yahagi, Naohisa

PY - 2014/10/21

Y1 - 2014/10/21

N2 - Background: Endoscopic full-thickness resection (EFTR) is expected to make possible minimally invasive local resection of early gastric cancer (EGC). However, no consensus exists regarding how far an optimal safety margin should be set in determining the resection area by endoscopy. We aimed to investigate the optimal lateral margin of EGC which could be a candidate for EFTR by measuring the subepithelial extent (SE) of tumors.Methods: In 60 surgically resected submucosal EGCs 4 cm or smaller, 595 prepared slides which showed lateral tumor borders both on the epithelial surface and on the subepithelial layer were assessed. The distance between the epithelial and the subepithelial tumor edge was measured under microscopic observation, followed by analyses of the relationship between the measured SE and the histological characteristics.Results: The average and the median SE were 1.1 mm (standard deviation 1.8 mm) and 0.3 mm (range 0–12.3 mm), respectively. The 99th percentile was 8.8 mm. With regard to the histological type, the median SE was significantly greater in diffuse-type tumor than in intestinal-type tumor (0.9 mm vs 0 mm, p < 0.0001). With regard to the location of the subepithelilal tumor edge, the median SE was significantly greater in the submucosal layer than in the mucosal layer (2.6 mm vs 0.3 mm, p < 0.0001).Conclusions: In most lesions, the SE was less than 1 cm. A safety margin may be set at 1 cm in EFTR of submucosal EGC.

AB - Background: Endoscopic full-thickness resection (EFTR) is expected to make possible minimally invasive local resection of early gastric cancer (EGC). However, no consensus exists regarding how far an optimal safety margin should be set in determining the resection area by endoscopy. We aimed to investigate the optimal lateral margin of EGC which could be a candidate for EFTR by measuring the subepithelial extent (SE) of tumors.Methods: In 60 surgically resected submucosal EGCs 4 cm or smaller, 595 prepared slides which showed lateral tumor borders both on the epithelial surface and on the subepithelial layer were assessed. The distance between the epithelial and the subepithelial tumor edge was measured under microscopic observation, followed by analyses of the relationship between the measured SE and the histological characteristics.Results: The average and the median SE were 1.1 mm (standard deviation 1.8 mm) and 0.3 mm (range 0–12.3 mm), respectively. The 99th percentile was 8.8 mm. With regard to the histological type, the median SE was significantly greater in diffuse-type tumor than in intestinal-type tumor (0.9 mm vs 0 mm, p < 0.0001). With regard to the location of the subepithelilal tumor edge, the median SE was significantly greater in the submucosal layer than in the mucosal layer (2.6 mm vs 0.3 mm, p < 0.0001).Conclusions: In most lesions, the SE was less than 1 cm. A safety margin may be set at 1 cm in EFTR of submucosal EGC.

KW - Early gastric cancer

KW - Endoscopic full-thickness resection

KW - Subepithelial extent

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