A 4cm-sized elevated type EGC. EndoTODAY 이준행

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73 years old male. About 4cm sized elevated lesion was found at the posterior wall of the gastric antrum. The biopsy showed well differentiated tubular adenocarcinoma. Would you recomment surgery?

I recommended surgery.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at antrum and posterior wall
2. Gross type : EGC type I
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size : 3.4x2.7 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 8.5 cm, distal 3.3 cm
8. Lymph node metastasis : no metastasis in 42 regional lymph nodes (pN0) (0/42: "1", 0/7; "3", 0/8; "4", 0/8; "5", 0/0; "6", 0/2; "7", 0/9; "9", 0/3; "8a", 0/2; "11p", 0/0; "12a", 0/3; "4sb", 0/0)
9. Lymphatic invasion : present (++)
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0

Do you have any comments on this case? There are a lot of tricky points in the management of slightly over the absolute indication cases.