Is It Reasonable to Treat Early Gastric Cancer with Mucosal Infiltration and Well Differentiation by Endoscopic Submucosal Resection?

Feng, Fan; Sun, Li; Xu, Guanghui; Hong, Liu; Yang, Jianjun; Guo, Man; Lian, Xiao; Zhang, Hongwei

doi:10.1007/s11605-015-2932-y

Cited by 15 publications

(13 citation statements)

References 33 publications

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“…Overall, the prevalence of LNM in patients with EGC of this cohort was 14.2%, which was similar to that reported in other centers in China, the United States, Brazil, France and Germany, but not in Japan and Korea in which significantly lower frequency of LNM were observed. In this study we found five independent risk factors of LNM in EGC, including a tumor size of ≥3.0 cm, deep submucosal invasion (SM2), moderate/poor tumor differentiation, LVI and tumor necrosis.…”

Section: Discussionsupporting

confidence: 89%

Risk factors of lymph node metastasis in 734 early gastric carcinoma radical resections in a Chinese population

Gan

Jiang

et al. 2018

J of Digest Diseases

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Section: Discussionsupporting

confidence: 89%

Risk factors of lymph node metastasis in 734 early gastric carcinoma radical resections in a Chinese population

Gan

Jiang

et al. 2018

J of Digest Diseases

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“…Since we performed endoscopic resection for 64 intramucosal cancer cases with very low LNM risk in Zhongshan Hospital during the study period, LNM incidence could be 8.9% if endoscopically treated cases were included. The LNM incidence was similar to data reported by Huang (6.4%) ( 20 ), Feng (8.3%) ( 21 ) and Degiuli (10.8%) ( 22 ). There are several differences in diagnostic criterion between Western and Japanese pathologists ( 23 ).…”

Section: Discussionsupporting

confidence: 89%

Expanded endoscopic therapy criteria should be cautiously used in intramucosal gastric cancer

Wang

Zhang

Fang

et al. 2016

Chinese Journal of Cancer Research

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ObjectiveAccurate estimation of lymph node metastasis (LNM) in intramucosal gastric cancer is essential to select less invasive treatment options and even avoid surgery. The aim of this study was to evaluate combined clinicopathological features to predict the presence of LNM.MethodsA retrospective review of data from 386 intramucosal gastric cancer patients who underwent gastrectomy with extended lymphadenectomy from 2003 to 2010 was conducted. The mutual relation between clinicopathological characteristics and LNM was analyzed. ResultsLNM was detected in 40 (10.4%) of the 386 patients. Histological type and vascular or lymphatic invasion presence showed a positive correlation with LNM occurrence by univariate analysis. Multivariate analysis revealed that histological type was the only factor associated with LNM. Combined clinicopathologic characteristics would be more predictable for LNM. We found no LNM when we used combined clinicopathological characteristics conforming to Japanese absolute indications for endoscopic therapy. The LNM rate was as high as 8.7% when Japanese expanded criteria were used. Univariate analysis in cancer conformity to expand endoscopic submucosal dissection (ESD) indication also revealed that the undifferential type was the only significant factor for LNM. ConclusionsIt was possible to predict intramucosal gastric cancer cases without LNM using combined clinicopathological characteristic analysis. Extended indication for ESD should be cautiously used for intramucosal gastric cancer patients.

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“…[99][100][101] Additionally, studies reported no significant difference between the five-year survival rate of surgical resection and endoscopic resection (92.0%-97.2% vs. 93.3%-96.4%), indicating that endoscopic resection is considered curative for the aforementioned lesions with no requirement of further treatment. 95,100,[102][103][104][105][106][107][108][109] Surgical resection is the standard treatment for clinically suspected submucosal invasive gastric cancer in preoperative evaluation. However, studies analyzing pathologic results of patients who underwent gastrectomy due to preoperatively suspected submucosal invasion reported that 28.8%-43.0% of these lesions could have been treated with endoscopic resection.…”

Section: Statement G3: We Recommend Endoscopic Resection For Early Gamentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Is It Reasonable to Treat Early Gastric Cancer with Mucosal Infiltration and Well Differentiation by Endoscopic Submucosal Resection?

Abstract: The most important factors for predicting lymph node metastasis in early gastric cancer are tumor size, pathological type, depth of invasion, and lymphatic-vascular invasion. Well-differentiated mucosal gastric cancers could be candidates for ESD.

Cited by 15 publications

References 33 publications

Risk factors of lymph node metastasis in 734 early gastric carcinoma radical resections in a Chinese population

Risk factors of lymph node metastasis in 734 early gastric carcinoma radical resections in a Chinese population

Expanded endoscopic therapy criteria should be cautiously used in intramucosal gastric cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

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