Updated evidence on endoscopic resection of early gastric cancer from Japan

Fujishiro, Mitsuhiro; Yoshida, Shuntaro; Matsuda, Rie; Narita, Atsushi; Yamashita, Hiroharu; Seto, Yasuyuki

doi:10.1007/s10120-016-0647-8

Cited by 35 publications

(21 citation statements)

References 44 publications

(82 reference statements)

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“…If SNNS is clinically developed as a safe surgical approach based on the findings obtained, the clinical application of SNNS will be extensively extended among patients with early gastric cancer. Furthermore, advances have been made in endoscopic treatments for patients with early malignancies, including gastric cancer 35, 36. Therefore, ESD with laparoscopic SBD may become the ultimate stomach‐preserving surgery for avoiding lymph node recurrence in selected patients with extended indications for ESD; however, further studies are needed prior to its expansion as a surgical approach.…”

Section: Future Prospects For Snns As a Minimally Invasive Approachmentioning

confidence: 99%

Novel surgical approach based on the sentinel node concept in patients with early gastric cancer

Natsugoe

Arigami

Uenosono

et al. 2017

Annals of Gastroent Surgery

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Recent prospective multicenter trials have demonstrated the clinical safety and efficacy of sentinel node navigation surgery (SNNS) in patients with early gastric cancer. Further, development of an intraoperative imaging system and an indocyanine green fluorescence imaging approach has been attracting attention as a novel tool for detection of the sentinel node (SN). The greatest advantage of an in vivo imaging system is that it visualizes SN and afferent lymphatic vessels from the primary tumor site more clearly than the conventional dye approach. Besides visualization of the SN, it is also essential to accurately assess the presence or absence of lymph node metastasis in the intraoperative management of SNNS. However, the clinical significance of lymph node micrometastasis (LNM) in patients with gastric cancer remains controversial. Reverse transcription‐polymerase chain reaction (RT‐PCR) is one of the representative assays used to identify LNM. A rapid RT‐PCR assay that completes the detection of LNM within approximately 40 minutes has recently been produced and applied in the clinical management of SNNS. From the viewpoint of surgical methods, modified laparoscopic and endoscopic cooperative surgery with non‐exposed approaches has recently been highlighted as a promising technique to prevent tumor dissemination caused by surgical procedures, and is likely to be clinically applied to SNNS in the future. When carrying out SNNS as a minimally invasive surgery, it is important to consider the balance between post‐surgical quality of life and curability. Future prospective studies on SNNS will greatly contribute to furthering its establishment as a beneficial procedure for patients with early gastric cancer.

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Section: Future Prospects For Snns As a Minimally Invasive Approachmentioning

confidence: 99%

Novel surgical approach based on the sentinel node concept in patients with early gastric cancer

Natsugoe

Arigami

Uenosono

et al. 2017

Annals of Gastroent Surgery

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“…ESD enables a higher en bloc and pathologically complete resection rate and lower local recurrence compared to EMR . The ESD procedure was covered by Japanese national health insurance in 2006 and has replaced EMR, comprising over 90% of ER for EGC in 2015 …”

Section: Emr and Esdmentioning

confidence: 99%

“…[29][30][31] The ESD procedure was covered by Japanese national health insurance in 2006 and has replaced EMR, comprising over 90% of ER for EGC in 2015. 32…”

Section: Introductionmentioning

confidence: 99%

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

Hatta

Gotoda

Koike

et al. 2019

Digestive Endoscopy

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Japanese guidelines for gastric cancer treatment were first published in 2001 for the purpose of showing the appropriate indication for each treatment method, thereby reducing differences in the therapeutic approach among institutions, and so on. With the accumulation of evidence and the development and prevalence of endoscopic submucosal dissection (ESD), the criteria for the indication and curability of endoscopic resection (ER) for early gastric cancer (EGC) have expanded. However, several problems still remain. Although a risk-scoring system (eCura system) for predicting lymph node metastasis (LNM) may help treatment decision in patients who do not meet the curative criteria for ER of EGC, which is referred to as eCura C-2 in the latest guidelines, additional gastrectomy with lymphadenectomy may be excessive for many patients, even those at high risk for LNM. Less-invasive function-preserving surgery, such as non-exposed endoscopic wall-inversion surgery with laparoscopic sentinel node sampling, may overcome this problem. In addition, further less-invasive treatment, such as ER with chemotherapy, should be established for patients who prefer not to undergo additional gastrectomy. CONCEPT AND UPDATE OF THE JAPANESE GUIDELINESJ APANESE GASTRIC CANCER Association (JGCA) guidelines were first published in 2001 9 for the purpose of: (i) showing the appropriate indication of each treatment method for gastric cancer; (ii) reducing differences in the therapeutic approach among institutions; (iii) improving the safety and outcome of treatment for gastric cancer; (iv) reducing the personnel and economic burden by avoiding unnecessary treatment; and (v) improving mutual understanding between medical staff and patients. With the accumulation of evidence, the guidelines were updated in

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“…In fact, over 90% of ER for EGCs is ESD in Japan. 24 Given its potential advantages over EMR, this procedure has begun to gain traction in some Western countries as well. 25 With the development of the ESD technique since the first English report in 1999, 26 the indication of ER for EGCs has expanded.…”

Section: Introductionmentioning

confidence: 99%

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

et al. 2020

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Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established. (Gut Liver 2020;14:412-422 ) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Updated evidence on endoscopic resection of early gastric cancer from Japan

Abstract: Background Endoscopic resection for early gastric cancer (EGC) plays a central role in the treatment of EGC in Japan. However, there is still room for improvement, and it is necessary to summarize the recently obtained knowledge from Japan for further improvement.

Cited by 35 publications

References 44 publications

Novel surgical approach based on the sentinel node concept in patients with early gastric cancer

Novel surgical approach based on the sentinel node concept in patients with early gastric cancer

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

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