A Study of Early Gastric Carcinoma

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This paper is to discuss the clinical aspects, endoscopic findings, gross findings of resected specimens, and pathohistological features of the so-called early carcinoma of the stomach with a reference to its surgical management. The material consisted of a total of 70 cases with 80 lesions encountered in our clinic and affiliated hospitals during the period of January, 1961 to December, 1967.I Clinical aspects. 1) The type IIc and the type IIc+III or IIc+ (III) were predominant, accounting for 27.1% and 31.4% respectively. 2) They were found most frequently in the fifth decade with the average age being 53.3 years old. The polypoid lesions, namely the type I and the type II a, tended to be encountered in higher ages in contrast to the type IIc and the type IIc+ III or IIc +(III). 3) The incidence of early gastric cancer was approximately 1.8% of all resectable gastric cancers after 1965. 4) Epigastralgia was the most frequent symptom being noted in 45.2% of the cases. However, 33.3% of the cases were asymtomatic. 5) The lesions were multiple in 11.4% of the cases. The tendency of multiplicity was particularly high in the types I and IIa. 6) Most of the lesions were situated in the antrum or the middle portion of the stomach. 7) Many lesions were less than 2cm in dimensions and there was a certain correlation between the size of the lesions and the depth of cancer infiltration. However, submucosal infiltration didd exsist in minute lesions less than 1cm in diamater. 8) Lymphnode metastasis was found in 8.3% and 13.3% in intramucosal cancers and those with subm ucosal infiltration respectively, with the average being 11.9%. Of three cases of the types I and II a with submucosal infiltration, two cases were found to be associated withh lymphnode matastasis. 9) All cases were adenocarcinoma.II Endoscopic diagnosis. 1) The type I and the type IIa. (1) In polypoid lesions, constriction of the neck, the size over 2cm, lobulated appearance andd extreme irregularity of the surface appeared to be significant indicators of malignancy. (2) Abnormalcy of the color seemed nonsignificant in diagnosis of malignancy of these types. (3) Polyps with atypical epithelium were difficult to differentiate from malignancy. 2) The type IIc, the type IIc+III and the type IIc+(III). (1) These types are similar to each other inn that the depressed surface with erosions are dominant. (2) Moth-eaten appearance is important. (3) The presence of radiating folds are indicative of the presence of III, and irregular thinning and/or abrupt ending of the folds along the margins of the depressed area are important features. Also significant is the occasional presence of islets withinn the lesions. (4) Variegated appearance in shape and color is important in these types. 3) The type III+IIc. Ulceration in this type is usually large, concealing the findings of depression(IIc) around it. Irregular thinning and/or abrupt ending of the converging folds should be carefully examined. 4) Miscellaneous types consisted of various combi-nations of the above mentioned types. Characteristics of each constituent type should be cautiously looked at.III Surgical considerations. 1) In the cases in which the macroscopic borde-rline is clear, resection 1cm apart from the lesion is usually sufficient. If, however, borderline is indistinct, operative cytology or frozen section is needed to decide the line of resection. 2) Lymphnode metastases were mostly confined to the primary nodes. Since, however, a secondary node involvement was found in one case, we would advocate dissection up to the secondary nodes.
社団法人日本消化器内視鏡学会の論文

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城島嘉昭
東京大学医学部分院外科教室

A Study of Early Gastric Carcinoma

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