Endoscopic laser therapy in the curative and palliative treatment of upper gastrointestinal cancer

Abstract

Endoscopic laser treatment was initially applied for gastrointestinal bleeding, but has been actively extended, especially in Japan, to the curative treatment of early upper gastrointestinal cancers. We have treated 10 cases of early gastric cancer and 1 case of early esophageal cancer by Nd-YAG laser radiation, and 2 cases of early gastric cancer by photochemical therapy (PCT) with argon laser + hematoporphyrin derivative. Also, 62 cases of advanced cancer were treated, 10 of the esophagus and 52 of the stomach, for bleeding (18 cases) or stenosis (34 cases). The cases were nonresectable or they were patients who refused surgery. Satisfactory results were obtained by treatment with YAG laser, but have not yet been obtained with PCT. In order to find indications for the possible extension of endoscopic laser therapy to operable cases of early gastric cancer, we studied lymph node metastases in 200 cases of early gastric cancer surgically treated by us. It was found that early gastric cancers (both mucosal and submucosal) measuring less than 2 cm in diameter, of type I, IIa, and IIc (without ulcer scar), had no lymph node metastases and such cases can be treated by local therapy--such as endoscopic laser therapy. In palliative endoscopic laser therapy for complications of advanced gastrointestinal cancers, there are no major problems with active performance. We obtained a high (90%) hemostatic rate in bleeding cases of upper gastrointestinal cancer and a satisfactory (65%) rate of dilating effect in cases of cancerous stenosis at the esophagus and cardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction caused by stomach cancer

“…Although surgical palliation is an available option in such patients, the results of palliative gastric bypass surgery are poor with high rates of morbidity and mortality [6][7][8] . Because of the limitations of surgery and because many patients are elderly, frail, and in an advanced stage of disease, various techniques for restoration of bowel function by non-surgical means (eg, balloon dilation and laser photoablation) have been proposed; all have met with limited success [9,10] . Since the endoscopic application of SEMS to malignant gastric outlet obstruction in the early 1990s, the use of SEMS to pass through an obstructing neoplasm with minimal morbidity has become increasingly widespread.…”

Micrometastasis in lymph nodes of mucosal gastric cancer

“…More nodal involvement occurred in tumors larger than 1.0 cm in superficial diameter (21%), then in those with depressed macroscopic type (IIc or III; 23%) and in those with ulcer formation (36%), but no Macroscopic type, according to reference [13] b Histological type, according to reference [13] cally, the incidence of lymph node metastasis in mucosal gastric cancer has been reported as 1.3% to 5.0% [11,12,[15][16][17]. Recently, it has been reported that mcancer with a tumor smaller than 2 cm in diameter, of the well differentiated type or the elevated macroscopic type, has no lymph node metastasis.…”

“…Recent investigations have reported that micrometastases to lymph nodes that were overlooked by ordinary hematoxylin and eosin (H&E) staining could be detected by cytokeratin (CK) immunostaining, and these so-called micrometastases were found to have prognostic significance [7][8][9][10]. Mucosal gastric cancer (m-cancer) has been the prime candidate for less invasive surgery or endoscopic mucosal resection (EMR) [11,12]. However, the frequency or outcome of occult involvement in lymph nodes from m-cancer remains unclear.…”

The Role of Thoracic Surgery in Palliative Care: A Review

“…[8]. The Nd: YAG laser and PDT are also effective options for managing bleeding from an unresectable esophageal tumor [9,10].…”