Endoscopic Resection of Early Gastric Cancer

Tada, Masahiro; Murakami, Akinobu; Karita, Mikio; Yanai, Hideo; Okita, Kiwamu

doi:10.1055/s-2007-1010365

Cited by 387 publications

(239 citation statements)

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“…Multicenter clinical trials have also shown that ESD has lower rates of local residual tumor and recurrence than EMR [15]. Tada et al [1] reported local recurrence in 6 (6.9 %) of 87 patients with early gastric cancer who underwent EMR by strip biopsy. All 6 patients with local recurrence had undergone incomplete resection.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic mucosal resection (EMR) was initially performed by strip biopsy [1], followed by the development of techniques such as EMR with a cap-fitted panendoscope (EMRC) [2] and endoscopic aspiration mucosectomy (EAM) [3,4]. In the latter half of the 1990s, techniques for endoscopic submucosal dissection (ESD) were developed and gained popularity [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

et al. 2013

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Background Few studies have compared the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in patients with early gastric cancer. Methods We studied 780 lesions for which endoscopic treatment was indicated according to the Japanese Gastric Cancer Association (JGCA) criteria or the Results The median follow-up was 73 months in the EAM group and 65 months in the ESD group. Overall, the local recurrence rate was significantly lower in the ESD group (0.2 %, 1/421) than in the EAM group (4.2 %, 15/359) (p \ 0.05). For lesions meeting the JGCA criteria, the local recurrence rate was 2.9 % in the EAM group and 0 % in the ESD group (p \ 0.05). For lesions meeting the NCC criteria, the local recurrence rate was 12.5 % in the EAM group and 0.6 % in the ESD group (p \ 0.05). There was no significant difference between the groups in overall survival. Conclusions On long-term follow-up, ESD was associated with a lower rate of local recurrence than EAM for lesions that met the JGCA or the NCC criteria. From the point of view of radical curability, ESD can be recommended for the management of lesions that meet either set of criteria.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

et al. 2013

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“…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%

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

et al. 2001

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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.

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A risk score for predicting outcome in patients with gastric cancer, based on stage, sialyl-Tn immunoreactivity and ploidy—a multivariate analysis

et al. 1996

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The use of prognostic indexes, based on multivariate analyses, has been described in thyroid cancer (Byar et al., 1979), acute lymphoblastic leukaemia (Palmer et al., 1980) and breast cancer (Sigurdsson et al., 1990). The analysis of prognostic factors accompanying the development of prognostic indices in gastrointestinal tumours is important, as it would improve our knowledge of these diseases and might therefore have consequences regarding the choice of therapy. The overall 5-year survival rate for patients with gastric cancer is poor, usually less than 20% (Wanebo et al., 1993). The recommended surgical treatment is total gastrectomy with more or less extensive lymph-node dissection (D1-D3). However, carcinomas restricted to the mucosa (early gastric cancer) have been resected locally by endoscopy with good results (Tada et al., 1993). Recently, Ichikura et al. (1995) proposed a discriminant score based on depth and horizontal spread of cancer in the submucosa to select those patients who might be treated by endoscopic rnucosal resection, as only 15 to 25% of these patients have lymph-node involvement (Iriyama et al., 1989;Lawrence and Shiu, 1991;Maehara et al., 1992;Moreaux and Bougaran, 1993;Sano et al., 1992). It would be of great importance to ascertain the differences in prognosis of patients within each stage (UICC, 1987) in order to select the optimal treatment modalities for the patients.The value of the immunohistochemical expression of p53, Sialyl-Tn antigen (STn) and Ki-67 antigen and of flowcytometric data together with other, more traditional variables in predicting outcome of gastric cancer patients has been described earlier (Victorzon et al., 1996a,b,c). We have shown that Sialyl Tn antigen (STn) expression and aneuploidy are significant independent prognostic factors in addition to stage (Victorzon el al., 1996b,c). In this study we further investigated the combination of these variables in order to define a risk score that could divide the patients more precisely into groups with different prognoses. days of operation were excluded. Due to background debris or insufficient number of intact cells, the DNA index could not be calculated in 16 tumours, and the S-phase fraction could not be calculated in 43 tumours. Thus 196 patients were suitable for multivariate analysis. Survival analysisTwelve variables, Ki-67, p53, STn, ploidy, S-phase fraction, age, gender, tumour location, stage, LaurCn (1965) type, lymph-node metastases, and distant metastases were studied individually by univariate analysis and the effect of each variable on prognosis was analysed individually by calculating Kaplan-Meier survival-duration curves. The differences in survival were calculated using the log-rank test (Peto et al., 1977). When the variable analysed consisted of 3 or more ordered categories, log-rank for trend was used.A proportional hazards model (Cox, 1972) was used for the multivariate analysis of all variables which were significant in the log-rank test. Variables were selected in a stepwise fashion with...

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Endoscopic Resection of Early Gastric Cancer

Cited by 387 publications

References 0 publications

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

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

A risk score for predicting outcome in patients with gastric cancer, based on stage, sialyl-Tn immunoreactivity and ploidy—a multivariate analysis

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