title: Can we resect EGC with Signet ring cells in Europe?
abstract: OBJECTIVE
  The proposed guideline for performing endoscopic resection of early gastric carcinoma (EGC) in Paris classification is a well-differentiated carcinoma with maximum involvement Sm1. Signet ring cell carcinomas (SRC) are excluded from this recommendation. Authors from Eastern countries have proposed extending this resection to include selected undifferentiated EGC. Via an analysis of a series of cases of signet ring carcinoma, we will discuss whether it is possible to resect EGC with signet ring cells in Europe.
  
  
  METHODS
  We retrospectively included patients with histological classification pT1 of EGC showing SRC. Data was extracted from the hospital gastrectomy register. Lymphadenomectomy D1.5 was performed on all patients. Histology results were retrospectively obtained from the electronic patient file.
  
  
  RESULTS
  Twelve patients (mean age = 55.4, four women, eight men) underwent surgery, without previous chemotherapy, between 2000 and 2012, for EGC with SRC. Mean size of the lesions was 20.2 mm (5-35 mm). Seven lesions were located in the antrum, five in the fundus. In the case of nine patients, histology showed no lymphovascular involvement. None of these nine patients presented lymph node metastases (LNM). Five patients had intramucosal carcinoma, four were classified as Sm1, one patient was Sm2, and one patient was Sm3. On surgery, the three patients with lymphovascular invasion showed LNM.
  
  
  CONCLUSIONS
  Endoscopic resection of EGC with SRC does not systematically imply complementary treatment by surgery, although criteria for endoscopic resection are difficult to determine because of the lack of data in Europe.
authors.affiliation: Endoscopy unit, Paoli Calmette Institute, 232 bd Ste Marguerite, 13009, Marseille, France, fcaillol@free.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.forename: Erwan
authors.initials: E
authors.lastname: Bories
authors.forename: Jerôme
authors.initials: J
authors.lastname: Guiramand
authors.forename: Christian
authors.initials: C
authors.lastname: Pesenti
authors.forename: Florat
authors.initials: F
authors.lastname: Poizat
authors.forename: Geneviève
authors.initials: G
authors.lastname: Monges
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000556:secondary / Q000601:surgery*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
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