Endoscopic Resection of Early Gastric Carcinoma: Results of a Retrospective Analysis of 308 Cases

Takekoshi, T; Baba, Yoshifumi; Ôta, Hideo; Kato, You; Yanagisawa, Akio; Takagi, Koichi; Noguchi, Yasuhiko

doi:10.1055/s-2007-1008990

Cited by 204 publications

(127 citation statements)

References 0 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…A variety of minimally invasive treatments for early gastric cancer have been reported, such as EMR [1][2][3][4], laparoscopic wedge resection [5], and laparoscopic intraluminal surgery [6]. However, these operations do not include regional LN dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it would seem logical to carry out the resection of perigastric LNs, at least for patients with early gastric cancer. In this respect, LADG has higher curability (similar to that of conventional ODG with regional LN dissection) than that of the above-mentioned operations [1][2][3][4][5][6]. However, the usefulness of and indications for LADG still remain unclear.…”

Section: Discussionmentioning

confidence: 99%

“…New techniques, such as endoscopic mucosal resection (EMR) [1][2][3][4], laparoscopic partial resection [5], and intragastric surgery [6], have been reported as minimally invasive surgery for early gastric cancer. However, in these operations, the regional lymph nodes (LNs) around the primary tumor cannot be resected.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer

et al. 2001

View full text Add to dashboard Cite

Generally, LN metastases are seen in a small percentage of patients with early gastric cancer with mucosal or submucosal invasion [7]. In recent years, the technique of laparoscopy-assisted distal gastrectomy (LADG) with regional LN dissection has been developed and employed for early gastric cancer [8]. In March, 1997, we began to perform LADG as a minimally invasive surgery for early gastric cancer. However, the feasibility of LADG for early gastric cancer and the associated clinical outcome of patients who undergo LADG for early gastric cancer remain unclear.We therefore conducted a review of patients who underwent LADG for early gastric cancer, in an effort to compare the operative times, intra-operative blood loss, number of removed lymph nodes, postoperative recovery, and morbidity and mortality rates of LADG and conventional open distal gastrectomy (ODG). Our research was aimed at determining whether the laparoscopic procedure of LADG for early gastric cancer is really safe and minimally invasive, and whether or not the LADG improves quality of life, compared with ODG. Patients and methods PatientsThe patients were preoperatively diagnosed as having an early gastric cancer located in the lower or middle third of the stomach, from the results of endoscopy, endoscopic ultrasonography (EUS), and examination of biopsy specimens. The indications for LADG were that: (1) the tumor was located in the middle or lower part of the stomach, (2) the invasion of the tumor was limited to the mucosal layer or the submucosal layers (SM1). Results. The clinical and pathological backgrounds of the patients in the two groups were similar. The duration of surgery was not significantly different between the two groups, but the blood loss in the LADG group was significantly less than that in the ODG group. The number of removed lymph nodes was not significantly different between the two groups. The times to the first passing of flatus, first walking, and the restarting of oral intake; the length of hospital stay; and the duration of epidural analgesia were significantly shorter in the LADG group. The morbidity rate in the LADG group was lower than that in the ODG group. Conclusions. LADG is a safe and minimally invasive surgical technique, after which we can expect a faster recovery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer

et al. 2001

View full text Add to dashboard Cite

show abstract

“…Early gastric cancer has recently been treated by endoscopic mucosal resection (EMR) (Takekoshi et al, 1994). However, a disadvantage of this approach is that imaging cannot accurately diagnose lymph node micrometastasis.…”

Section: Lymphatic Invasion and Micrometastasis In Gastric Cancer T Amentioning

confidence: 99%

Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer

et al. 2005

View full text Add to dashboard Cite

The monoclonal antibody D2-40 is a specific lymphatic endothelial markers and D2-40 staining have been applicable to evaluate lymphatic invasion in various malignant neoplasms. In the present study, we investigated lymph node micrometastasis determined by immunohistochemistry (IHC) and reverse transcription -polymerase chain reaction (RT -PCR) in all dissected lymph nodes obtained from 80 patients with node-negative gastric cancer, and analysed the relationship between micrometastasis and clinicopathological findings including lymphatic invasion of the resected primary tumour using D2-40 immunohistochemical staining. The incidence of micrometastasis determined by IHC and RT -PCR was 11.3% (nine out of 80) and 31.3% (25 out of 80), respectively. Although haematoxylin -eosin (HE) staining revealed lymphatic invasion in 11.3% (nine out of 80) of patients, D2-40 staining uncovered new invasion in 23.8% (19 out of 80) of patients. In the diagnosis of HE and D2-40 staining, the incidence of micrometastasis was significantly higher in patients with lymphatic invasion than in those without lymphatic invasion (P ¼ 0.0150 and Po0.0001, respectively). Micrometastasis correlated more closely with D2-40 than with HE staining. We demonstrated a high incidence of micrometastasis and lymphatic invasion and a correlation between them even in pN0 gastric cancer. When planning less invasive treatment, the presence of such occult cancer cells should be considered.

show abstract

“…We know for certain that the protruded type EGC less than 2.0 cm in diameter is limited to the mucosa and that it lacks nodal metastasis (Kitaoka et al, 1984;Korenaga et al, 1986;Ohta et al, 1987;Iriyama et al, 1989). In addition, if a tumour shows a depressed differentiated adenocarcinoma less than 1.0cm in diameter, then it has little chance of nodal metastasis (Takekoshi et al, 1994). A limited procedure can be indicated in these cases only.…”

Section: Survivalmentioning

confidence: 99%

Rationale for extensive lymphadenectomy in early gastric carcinoma

Miwa

Miyazaki²,

Sahara³

et al. 1995

Br J Cancer

View full text Add to dashboard Cite

Summary The incidence of nodal metastasis in early gastric carcinoma (EGC) is 10-20%. However, the optimal nodal dissection for early gastric carcinoma has not been established. A retrospective study was conducted in 392 consecutive patients who underwent potentially curative distal gastrectomy for EGC between 1962 and 1990. Of these 295 patients treated after September 1972 were prospectively entered into an extensive lymphadenectomy protocol. These patients were compared with 97 patients with simple gastrectomy in respect of the causes of death after surgery and the 10 year disease-specific survival rate. The incidence of nodal metastasis in early gastric carcinoma patients was 13.0%. Operative mortality from extensive lymphadenectomy was almost the same as from simple gastrectomy (2.0% and 2.1% respectively). Extensive al., 1987; Ohta et al., 1987; Marczel et al., 1988;Lehnert et al., 1989;Percivale et al., 1989;Farley et al., 1992;Maehara et al., 1993). Nevertheless, the optimal extent of lymph node dissection for EGC has not been well established. Japanese surgeons normally perform extensive lymphadenectomy for EGC because a certain proportion of these patients have lymph nodal involvement and carcinoma recurrence is not rare. In contrast, most surgeons in Western countries do not use aggressive surgery (Cuschieri, 1986;Heberer et al., 1988;Irvin and Bridger, 1988;Heesakkers et al., 1994), perhaps because of uncertainty regarding improvement in the survival rate and the high operative risk associated with extensive lymph node dissection (Dent et al., 1988;Heberer et al., 1988;Irvin and Bridger, 1988).To evaluate the therapeutic value of extensive lymphadenectomy in EGC, we analysed retrospectively the causes of death after surgery and compared the 10 year disease-specific survival rate in patients who had received extensive lymphadenectomy with patients who had received simple gastric resection. (LLND). ELND was performed beginning in September 1972. The LLND group consisted of 68 patients before September 1972 and 29 patients after. Each surgical procedure is outlined below. The subjects were followed up, and the effect of lymph node dissection on their 10 year disease-specific survival was evaluated. The operative and pathological findings were assessed according to the guidelines of the Japanese Research Society for Gastric Cancer (1981). The median age of the patients at the time of operation was 59 years, with a range of 18-84 years. There were 271 males (69%) and 121 females (31%). SurgeryThe ELND gastrectomy was performed as follows: the entire greater omentum, superior leaf of the mesocolon, pancreatic capsule and lesser omentum were removed en bloc with the cancerous distal portion of the stomach. Each of the supplying gastric arteries was ligated and divided at its origin, and the group 1 lymph nodes (nl), namely those along the lesser and greater curvatures, as well as the supra-and infra-pyloric lymph nodes, were completely dissected. In addition, the group 2 lymph nodes (n2) located at the...

show abstract

Endoscopic Resection of Early Gastric Carcinoma: Results of a Retrospective Analysis of 308 Cases

Cited by 204 publications

References 0 publications

The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer

The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer

Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer

Rationale for extensive lymphadenectomy in early gastric carcinoma

Contact Info

Product

Resources

About