Pathological Characteristics of Early Gastric Cancer with Mapping of Resected Specimen

Lee, Jae Hyun; Kim, Jin Young

Abstract

BACKGROUND: Since the majority of patients with early gastric cancer have been shown long term survival after the curative surgical resection, some minor procedures, such as endoscopic mucosal resection have been introduced for improving the quality of life these patients. However, at this point, surgeons should pay special attention not only to the preoperative patient selection but also to the possible presence of remnant minute cancer after these minor procedures.
METHODS
Seventy-one early gastric cancer patients who had undergone surgical resection from 1990 to 1995 were analyzed. After resected specimens had been longitudinally divided into many 3 mmx3 cm pieces in a state of formalin fixation, all pieces of the specimens were observed microscopically and mapped on to the paper. The caracteristics of tumor, microscopical cancer, and dysplasia were all observed by one pathologist.
RESULTS
A total gastrectomy was performed in 4 patients, and a subtotal gastrectomy in 67 patients. Thirty-seven patient had mucosal cancer, and 34 had submucosal cancer. Regional lymph node metastases were positive in 10 patients; 2 with mucosal cancer and 8 with submucosal cancer. Lesions were located in the lower one-third of the stomach in 46 patients and at the lesser curvature in 43 patients. The most common type was II B in 23 cases, followed by II C in 16 cases and II B II C in 12. The average diameter of the cancer lesions was 2.92 cm, and lesions of over 4 cm in diameter were revealed in 20 patients. According to maps of the resected specimens, 43 cases include ulceration with cancer and 28 cases did not. Microscopical cancer was discovered in 10 cases, dysplasia in 12 cases, and double cancers in 4 patients. When the tumor size was over 2 cm, these findings became statistically significant (P=0.014, Fisher's exact test). With respect to tumor depth, tumor type, and histologic type with coexistance of other lesions, there was no statistical significance.
CONCLUSION
Preoperative patient selection is very important for minor procedures, and surgeons should be concerned with the coexistence of distant microscopical cancer, dysplasia, and double cancers during the minor procedures, especially when the tumor size is over 2 cm in diameter.