Gastric cancer. EndoTODAY

[Gastric cancer 790. Lymphovascular invasion in forceps biopsy specimen]

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Shallow ulcerative EGC was found in the 70 YO female. ESD was initially considered. In the repeated biopsy, however, there was lymphovascular invasion (pathology report: Tubular adenocarcinoma, M/D with lymphovascular invasion).

Would you recommend surgery or ESD?

I recommended surgery and the final pathology showed lymphatic invasion.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at antrum and anterior wall
2. Gross type : EGC type IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : mixed
5. Size : 1.5x1.0 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 6.5 cm, distal 4.0 cm
8. Lymph node metastasis : no metastasis in 30 regional lymph nodes (pN0)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0

ܺ ð Ҵٸ ð ð ġ Ḧ Դϴ . Ƿڵ ȯ 80% ð ESD ϰ ֽ ϴ . ܺ ּ 20% մϴ .

ȯ ڿ ð ˻翡 lymphovascular invasion ־ Ƿ , ٷ ESD Ͽ ̷ Դٸ ϴ . ֱٿ Ʒ ڷῡ ٰ Ͽ 2cm ۰ ٸ ڰ lymphatic invasion ִٸ , ԰ ESD specimen Ͽ lymphatic invasion ֱ Դϴ .

Maybe we are doing too much surgery after ESD. Do you think surgery is necessary for mucosal cancer with lymphovascular invasion? As you can see in the red box, in lymphovascular invasion positive patients within the traditional absolute indication ? mucosal cancer, differentiated type, no ulcer, less than 2 cm, there was no lymph node metastasis in surgery. Careful observation without additional surgery can be an option for this group of patients.

ESD ſ ġ ̸ , Ұ߿ Ͽ ū ̰ ߻ ֽ ϴ . ð ϴ Ե ؾ Դϴ . (1) ˻ ð ( ּ 5 ), (2) ڼ description, (4) ٰ ϰ ġ, ũ , , (4) Ȯ ˻ ... ʿ մϴ .