Gastric cancer. EndoTODAY

[Gastric cancer 814. EGC with mucinous component]

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A 77 years old female patient was referred for gastric ESD of an EGC of the gastric antrum. The forceps biopsy was "tubular adenocarcinoma, moderately differentiated with mucinous componant". Would you try ESD or recommend surgery?

I recommended surgery due to (1) unclear tumor border, (2) gastric wall thickening suggesting SM invasion, and (3) mucinous component. This is the final pathology.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at angle and anterior wall
2. Gross type : EGC type IIa
3. Histologic type : tubular adenocarcinoma, moderately differentiated >> mucinous adenocarcinoma (mucinous carcinoma portion: 30%)
4. Histologic type by Lauren : mixed
5. Size : 5.0x2.8 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 6.0 cm, distal 2.8 cm
8. Lymph node metastasis : no metastasis in 31 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : gastritis cystica profunda
13. AJCC stage by 8th edition: pT1a N0

It was a 5cm sized mucosal cancer with mucinous component.