Assessing the Suitability of Gastric Carcinoma for Limited Resection: Endoscopic Prediction of Lymph Node Metastases

Namieno, Tsutomu; Koito, Kazumitsu; Higashi, Tsunemi; Takahashi, Masato; Yamashita, Kazuo; Kondo, Yukifumi

doi:10.1007/s002689900482

Cited by 31 publications

(12 citation statements)

References 17 publications

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“…The incidence of lymph node metastasis is about 2%-5% in EGC patients with mucosal cancer and 11%-20% in those with submucosal cancer, as mentioned above [11][12][13]. Although there have been many studies pertaining to lymph node metastasis in EGC patients, the clinicopathological features of EGC without lymph node metastasis remain debatable.…”

Section: Early Gastric Cancer (Egc)mentioning

confidence: 99%

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

2006

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surgery, including less invasiveness, less pain, earlier recovery, and better cosmesis [2]. Kitano et al. [3] first applied and described laparoscopy-assisted distal gastrectomy (LADG) as treatment for early gastric cancer (EGC) in 1994.With the development of various diagnostic modalities and the spread of mass screening, EGC now accounts for more than 50% of the total incidence of gastric cancer in Japan. The low frequency of lymph node metastasis in patients with EGC is well known; it reportedly occurs in 2%-5% of those with mucosal cancer and 11%-20% of those with submucosal cancer [4]. To allow for the treatment of EGC in patients without a risk of lymph node metastasis, laparoscopic wedge resection (LWR) with a lesion-lifting method was developed by Ohgami et al. [5] in 1992, and intragastric mucosal resection (IGMR) was developed by Ohashi [6] in the early 1990s. With the recent development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) [7], the use of LWR and IGMR seems to be decreasing, whereas the use of LADG with lymph node dissection has increased in patients with EGC with a risk of lymph node metastasis.The past 15 years have seen remarkable advances in laparoscopic surgical techniques and instruments, such as laparoscopic coagulating shears [8]. Extended lymph node dissection (D2) and total gastrectomy can now be performed laparoscopically [9,10]. However, LADG remains controversial as a standard surgery for gastric cancer because there are few studies evaluating the technical difficulty, advantages, and oncological feasibility of LADG.Here, we review reports, in the English-language literature, of LADG with lymph node dissection as treatment for cancer, to clarify the current status of this technique and related problems. AbstractSince 1991, laparoscopic surgery has been adopted for the treatment of gastric cancer, and it has been performed worldwide, especially in Japan and Korea. We reviewed the English-language literature to clarify the current status of and problems associated with laparoscopic gastrectomy with lymph node dissection as treatment for gastric cancer. In Japan, early-stage gastric cancer (T1/T2, N0) is considered the only indication for laparoscopic gastrectomy. As yet, there is little high-level evidence based on long-term outcome supporting laparoscopic gastrectomy for cancer, but reports have provided level 3 evidence that the procedure is technically safe, and that it yields better short-term outcomes than open surgery; that is, recovery is faster, hospital stay is shorter, there is less pain, and cosmesis is better. However, investigation into the oncological outcome of laparoscopic gastrectomy as treatment for cancer is lacking. To establish laparoscopic surgery as a standard treatment for gastric cancer, multicenter randomized controlled trials to compare the short-and longterm outcomes of laparoscopic surgery versus open surgery are necessary.

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Section: Early Gastric Cancer (Egc)mentioning

confidence: 99%

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

2006

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“…However, lymph node metastasis is rare in patients with mucosal cancer, and is mostly restricted to the perigastric nodes in patients with node-positive EGC [22, 23, 24, 25, 26]. The incidence of lymph node metastasis in a large series of EGC ranges from 1 to 3% (1% [22], 2% [23, 27, 28], 3% [8, 29]) for tumors confined to the mucosa and from 11 to 20% (11% [22], 14% [30, 31, 32], 17% [23], 18% [28], 19% [27], 20% [8]) for tumors invading the submucosa.…”

Section: Prognostic Factorsmentioning

confidence: 99%

Modern Treatment of Early Gastric Cancer: Review of the Japanese Experience

Adachi

Shiraishi²,

Kitano³

2002

Dig Surg

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Background: Recently, detections of early gastric cancer (EGC) have been increasing, and the treatment strategies for gastric cancer have been changing. To demonstrate recent clinical experience of EGC in Japan and to assess modern strategies for the treatment of EGC, we investigated the English-language literature of the past 10 years through computer searches. Methods: This article intends to provide gastric surgeons with recent Japanese experience of the treatment for EGC. In a search for modern treatments of EGC, we selected 100 papers published in well-known medical journals, and focused on the following items of EGC: (1) prognostic factors, (2) endoscopic treatment, (3) surgical procedures, and (4) Japanese guidelines. Results: The most important factor influencing the survival of patients with EGC is the status of lymph node metastasis. The incidence of lymph node metastasis is 1–3% for mucosal cancers and 11–20% for submucosal cancers. Endoscopic mucosal resection (EMR) is a technique for the treatment of EGC, and the recent indication includes the tumors confined to the mucosa up to 3 cm in size or those invading the superficial submucosa. Surgical procedures include conventional Billroth I gastrectomy, limited resections, and laparoscopic surgery. Laparoscopic wedge resection using the lesion-lifting method and laparoscopy-assisted distal gastrectomy provide less pain, faster recovery and shorter hospital stay. Guidelines for the treatment of gastric cancer proposed by the Japanese Gastric Cancer Association show that patients with mucosal cancer can be managed by EMR or distal gastrectomy, whereas patients with submucosal cancer are candidates for distal gastrectomy with lymph node dissection. Conclusion: Although the prognosis of patients with EGC depends on the presence or absence of lymph node metastasis, most are successfully treated by modern endoscopic or surgical techniques. Laparoscopic surgery and limited resections will contribute to the better quality of life of patients with EGC.

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“…Of the 23 patients, one had normal EGD and 22 were identified to have 23 lesions. Targeted biopsy revealed high grade intraepithelial www.wjgnet.com Since endoscopy is an essential method in the diagnosis of gastrointestinal neoplasm and endoscopic appearance of a lesion plays an important role in predicting its characteristics and its invasion depth or metastasis [15] , macroscopic findings under conventional endoscopy were analyzed in this study, including macroscopic type, lesion size, location, mucosal ruga changes (e.g. convergence, tapering, abruption, etc) and presence of ulcer plaque or ulcer scar, all of which are easily accessible in daily practices.…”

Section: Differentiation Of "True Hgien" and Gastric Cancermentioning

confidence: 99%

Endoscopic features predictive of gastric cancer in superficial lesions with biopsy-proven high grade intraepithelial neoplasia

Wu¹,

Wu²,

Zhu³

et al. 2009

WJG

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AIM:To investigate the macroscopic and clinicopathologic features of gastric cancer in patients with biopsy-suggested high grade intraepithelial neoplasia. METHODS:Patients with biopsy-confirmed gastric high grade intraepithelial neoplasia were reviewed from January 2001 to March 2008. Pathologic sections were re-evaluated by two senior pathologists.Patients with an en-bloc resection of the lesion within two months after the diagnosis of high grade intraepithelial neoplasia were enrolled in the study. Clinical manifestations, endoscopic features, biopsy and surgical pathology of all patients were collected and analyzed. The data acquired were subjected to univariate and multivariate analysis. RESULTS:Seventy-two superficial gastric lesions with a pathologic diagnosis of high grade intraepithelial neoplasia based on biopsy specimens were enrolled. True high grade intraepithelial neoplasia was finally proved in 16 lesions and gastric cancer in the rest 56 lesions, most of which (96.4%) were differentiated carcinomas. The result of univariate analysis indicated that the size and the presence of marked ulcer plaque or scar in a superficial lesion were independently associated with gastric cancer (P < 0.05), when high grade intraepithelial neoplasia was diagnosed by biopsy pathology. The results of multivariate analysis revealed the size greater than 1.5 cm [odds ratio (OR) 18.400, P < 0.001] and the presence of 5-odd mm ulcer plaque or scar (OR 10.000, P = 0.044) were associated with gastric cancer. Accordingly, the sensitivity, specificity and negative predictive value of multivariate analysis for predicting "true high grade intraepithelial neoplasia" was 87.5%, 89.3% and 96.2%, respectively. CONCLUSION:Macroscopic findings are of value in differentiation between high grade intraepithelial neoplasia and superficial gastric cancer. This may simplify patient work-up and save costs for patients and healthcare system.

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Assessing the Suitability of Gastric Carcinoma for Limited Resection: Endoscopic Prediction of Lymph Node Metastases

Cited by 31 publications

References 17 publications

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

Modern Treatment of Early Gastric Cancer: Review of the Japanese Experience

Endoscopic features predictive of gastric cancer in superficial lesions with biopsy-proven high grade intraepithelial neoplasia

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