Early gastric cancer: A challenge in Western countries

Abstract

Early gastric cancer (EGC) is an invasive carcinoma involving only the stomach mucosa or submucosa, independently of lymph node status. EGC represents over 50% of cases in Japan and in South Korea, whereas it accounts only for approximately 20% of all newly diagnosed gastric cancers in Western countries. The main classification systems of EGC are the Vienna histopathologic classification and the Paris endoscopic classification of polypoid and non-polypoid lesions. A careful endoscopic assessment is fundamental to establish the best treatment of EGC. Generally, EGCs are curable if the lesion is completely removed by endoscopic resection or surgery. Some types of EGC can be resected endoscopically; for others the most appropriate treatment is surgical resection and D2 lymphadenectomy, especially in Western countries. The favorable oncological prognosis, the extended lymphadenectomy and the reconstruction of the intestinal continuity that excludes the duodenum make the prophylactic cholecystectomy mandatory to avoid the onset of biliary complications.

Risk of lymph node metastasis in early gastric cancer for a Western population

“…As the data was collected from a prospective Provincial Cancer Centre database, we were unable to capture patients who had ER but were not referred for further assessment. While inclusion of only surgically resected EGC patients may bias our results, we estimate that the rate of ER performed in our region between 2000 and 2017 was low 43 . Despite the use of multivariate analysis, there may have been unknown confounding factors that were not taken into account.…”

“…While inclusion of only surgically resected EGC patients may bias our results, we estimate that the rate of ER performed in our region between 2000 and 2017 was low. 43 Despite the use of multivariate analysis, there may have been unknown confounding factors that were not taken into account. For example, the retrospective nature of the study limited the ability to collect data on race/ethnicity of patients which is a factor known to influence the degree of LNM.…”

Pattern of Distribution of Lymph Node Metastases in Individual Stations in Middle and Lower Gastric Carcinoma

“…The presence of lymph node (LN) metastasis is one of the most significant prognostic factors in patients with gastric cancer (GC) [ 1 , 2 , 3 ]. Metastases occur during the early stages of the disease [ 3 , 4 , 5 , 6 ], and because their pre- and intra-operative diagnosis remain unreliable, a D2 lymphadenectomy should be performed whenever nodal involvement is suspected [ 6 , 7 , 8 , 9 , 10 ].…”

Lymphocyte subset is more suitable than systemic inflammatory response biomarker and immunoglobulin in constructing prognostic nomogram model for advanced gastric cancer

“…Although molecular targeted therapy and immunotherapy have shown successes in recent years, the 5-year survival rate of patients with advanced GC is still lower than 10% [ 5 , 6 ]. At present, these traditional classification tools based on tumor burden, presence of cancer cells in regional lymph nodes, and metastasis provide limited information in estimating prognosis and ameliorating the survival rate of patients with GC individually [ 7 ]. Therefore, it is time to develop simple, inexpensive, rapid, robust, and powerful serum biomarkers to guide the clinical treatment direction and predict prognosis, especially for advanced patients.…”