Super-Microscopic Full-Thickness Resection (SMIS-EFTR), an innovative surgical modality for early gastric cancer, is characterized by unique demands in specimen handling and pathological assessment. This study aims to establish standardized protocols for processing gastric cancer specimens following SMIS-EFTR and to define key elements of full-layer pathological diagnosis, with the goal of enhancing the precision of pathological evaluation.

A retrospective analysis was conducted on 8 cases of total gastrectomy conducted at the Department of Gastroenterology, First Medical Center of the PLA General Hospital, between February 2022 and November 2024.The primary objective was to optimize standardized protocols for managing "full-thickness-non-full-thickness" mixed resection margins during specimen processing, while also establishing specific evaluation metrics for the serosal surface.

All 8 surgical specimens demonstrated a well-preserved "inner full-thickness resection+ outer non-full-thickness dissection" mixed resection configuration.The mean longitudinal diameter of the specimens was (4.76±1.30) cm, while the tumors measured a mean longitudinal diameter of (1.46±0.96) cm.The average thickness of the full-thickness regions was (0.24±0.12) cm, and the mean distance from the non-full-thickness resection margin was(1.5±0.8)cm.Malignant involvement was observed in all specimens: 2 cases exhibited tumor invasion limited to the submucosa (SM1), 1 case reached SM3, and all achieved R0 resection (complete microscopic resection).

To address the "mixed resection" characteristic intrinsic to SMIS-EFTR, we developed specialized specimen processing protocols and a dual-layer (mucosal and serosal layers) evaluation system, thereby establishing a critical technical framework for precise pathological diagnosis.