Minimally invasive treatment for gastric cancer: Approaches and selection process

Abstract

Minimally invasive treatment of gastric cancer has emerged as a result of the technical advances, better understanding of gastric physiology, and more knowledge of the biologic behavior of gastric cancer. This treatment results in improved quality of life embodied by smaller incisions, reduced length of hospital stay, and a faster return to productive life. However, minimally invasive treatment for gastric cancer must take into consideration the potential effects of these techniques on tumor dissemination at the time of the treatment procedure, as well as the rates of recurrence and overall survival. Several technical treatment approaches to gastric cancer have now become possible, utilizing endoscopy, laparoscopy, or an open method. Endoscopic mucosal resection (EMR), limited resection, and laparoscopic surgical resection are the currently practiced modalities as the minimally invasive treatment. Lymph node dissection with the minimally invasive techniques is a barrier to its wide application. Although it is not commonly performed in Western countries, the use of minimally invasive treatment for gastric cancer is growing, especially in Korea and Japan. Minimally invasive treatment for early gastric cancer (EGC) has already been shown to be safe and effective in many retrospective series though no prospective randomized studies comparing it to open resection have been performed. Therefore, routine implementation of these procedures must await confirmatory outcomes generated by well-done randomized prospective clinical trials.

Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution

“…The prognosis is different between early and advanced gastric cancer. The average 5-year survival rate in patients with early gastric cancer is over 90%, and it is up to 94.2% in patients without lymph node metastasis (Noh et al, 2005). The incidence of lymph node metastasis in early gastric cancer range from 2.6% to 4.8% in mucosal cancers and 16.5% to 25% in submucosal cancer (Tsujitani et al, 1999;Kim et al, 2004;Roviello et al, 2006).…”

Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? a large‐scale Korean multi‐center study

“…Because of possible residual tumor and lymph node metastasis in case of submucosal invasion, gastrectomy with lymph node dissection should be considered regardless of margin involvement status after EMR/ESD. Furthermore, because most of the metastasized lymph nodes in patients with submucosal invasion were confined to level 1 group [24], laparoscopic gastrectomy with D1 þ b dissection can be the choice of further treatment.…”

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

“…The presence of lymph node metastasis in early gastric cancer results in a worse prognosis, as reported by Kitamura et al (1997) and Folli et al (2001). Noh et al (2005) reported that the 5-year survival rate of early gastric cancer without lymph node metastasis is 94.2% and that of early gastric cancer with lymph node metastasis is 87.3%. Nio et al (1993) reported a 5-year survival rate of 95% for N1 patients and 68.4% for N2 patients for early gastric cancers, and Miwa et al (1984) observed similar rates of 90% and 79%, respectively.…”