Modified treatment of early gastric cancer: Evaluation of endoscopic treatment of early gastric cancers with respect to treatment indication groups

Abstract

The results of endoscopic treatment of early gastric cancers were evaluated. The lesions were divided into two groups: the group with an absolute indication (AI) and the other with a relative indication (RI) for endoscopic treatment. Endoscopic mucosal resection (EMR) was performed on 106 lesions in 104 patients. In addition, 108 patients were treated by laser irradiation (LI). The status of the patients were serially assessed during the postoperative period. The residual rate in AI patients who underwent EMR was 30.3%, whereas the rate in RI patients was 80%. The residual rate in 70 AI patients who underwent LI was 0%. Although the recurrence rate was 4.2%, the cumulative curative rate after additional treatments was 100%. The residual rate in RI patients who underwent LI was 17.4%, and the recurrence rate was 13.2%. The cumulative curative rate after additional treatments was 97.4%. In AI patients, the initial mode of treatment use was EMR. Patients who exhibited residual cancerous tissue after EMR or those in whom EMR was difficult to perform, either technically or otherwise, underwent LI. EMR was the first choice therapeutic technique because endoscopic specimens obtained could be subjected to histopathologic examination. In RI patients, the conventional operation was the therapeutic technique of first choice. The LI procedure was performed in those who either refused surgery or who could not undergo operative treatment for various reasons.

Early gastric cancer: Report of 58 cases

“…With strict selection criteria, a cumulative curative rate of 98.4% has been reported [40]. According to Maekawa et al [25], the best results would be expected in patients who have tumors of the differentiated type measuring 20 mm or smaller without depression, since lymph node metastases were rare in these variants.…”

Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp

“…The five-year survival rate was 86%, a rate similar to more aggressive surgical approaches [58] . Hiki et al [59] reported a recurrence rate of 4.2% in their series. The main disadvantage of endoscopic methods is the risk of incomplete tumor resection.…”

Minimally invasive surgery for gastric cancer in UK: current status and future perspectives

“…The value of EMR and ESD has been proven effective in the management of early gastric cancer in several retrospective and prospective cohort studies but lack of high quality randomized controlled trial remains a challenge before routine use of this approach worldwide (52)(53)(54)(55)(56)(57). Considering that bleeding risk does not differ between ESD and EMR and that the perforation risk does not usually lead to life-threatening disease, therefore the benefit of ESD can outweigh the overall harm when compared with EMR with the proviso that that the ESD is performed by experienced practitioners (58).…”