Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer

Abe, Nobutsugu; Mori, Toshiyuki; Takeuchi, Hirohisa; Yoshida, Takashi; Ohki, Atsushi; Ueki, Hisayo; Yamada, Osamu; Terabe, Masaki; Sugiyama, Masanori; Atomi, Yutaka

doi:10.1016/j.amjsurg.2005.05.042

Cited by 61 publications

(42 citation statements)

References 13 publications

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“…The incidence of lymph node metastasis is usually reported to be 5.7-20% for early gastric cancer in Japan and Western countries (Borie et al, 2000;Abe et al, 2005). This study found a 15.3% incidence of lymph node metastasis.…”

Section: Discussionsupporting

confidence: 49%

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

Wang¹,

Ma²,

Zhang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Early gastric cancer (EGC) is well accepted as having a favorable prognosis, but some patients experience an ominous outcome after curative resection. This study was aimed at evaluating predictive factors associated with prognosis of D2 gastrectomies in patients with early gastric cancer. Materials and Methods: A total of 518 patients with early gastric cancer who underwent D2 gastrectomies were reviewed in this study. The clinicopathological features and surgical outcomes were analyzed. The survival rate was estimated using the Kaplan-Meier method and compared by log rank test. Prognostic factors were analyzed using a multivariate Cox proportional hazards model. Results: The 5-year survival rate was 90.3%. Tumor infiltration, lymph node metastasis and lymphovascular invasion were significant prognostic factors for survival. Gender, age, tumor size, tumor location, macroscopic type and histological type were not significant prognostic factors. Multivariate analysis indicated that lymph node metastasis was an independent poor prognosis factor. Conclusions: Early gastric cancers with lymph node metastasis have a relatively poor prognosis after standard surgery. Even after curative resection, patients with EGC with positive lymph nodes should be closely followed and be considered as candidates for comprehensive therapies.

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Section: Discussionsupporting

confidence: 49%

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

Wang¹,

Ma²,

Zhang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…We prefer a two-handed technique, as in conventional surgery, and are now planning a clinical trial using magnetic-assisted ESD [83]. In order to further extend the indications for treating EGC with less invasive surgery, endoscopic resection combined with laparoscopic regional lymph-node dissection should be considered [84,85].…”

Section: Prospects For the Futurementioning

confidence: 99%

Endoscopic resection of early gastric cancer

2007

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The purpose of this review is to examine recent advances in the techniques and technologies of endoscopic resection of early gastric cancer (EGC). Endoscopic mucosal resection (EMR) of EGC, with negligible risk of lymph node metastasis, is a standard technique in Japan and is increasingly becoming accepted and regularly used in Western countries. EMR is a minimally invasive technique which is safe, convenient, and effi cacious; however, it is insuffi cient when treating larger lesions. The evidence suggests that diffi culties with the correct assessment of depth of tumor invasion lead to an increase in local recurrence with standard EMR when lesions are larger than 15 mm. A major factor contributing to this increase in local recurrence relates to lesions being excised piecemeal due to the technical limitations of standard EMR. A new development in endoscopic techniques is to dissect directly along the submucosal layer -a procedure called endoscopic submucosal dissection (ESD). This allows the en-bloc resection of larger lesions. ESD is not necessarily limited by lesion size and it is predicted to replace conventional surgery in dealing with certain stages of ECG. However, it still has a higher complication rate when compared to standard EMR, and it requires high levels of endoscopic skill and experience. Endoscopic techniques, indications, pathological assessment, and methods of endoscopic resection of EGC need to be established for carrying out appropriate treatment and for the collation of long-term outcome data.

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“…This raises the possibility of a new treatment strategy involving local resection and SN biopsy under laparoscopy for EGC when SN mapping becomes feasible. The combination of ESD and a laparoscopic procedure for LN dissection has the potential to become a new treatment strategy for EGC [8].…”

Section: Minimally Invasive Treatment Methods For Early Gastric Cancermentioning

confidence: 99%

“…This option lies between endoscopic resection and radical surgery in terms of invasiveness, and improves the quality of life of patients after surgery. Sentinel node (SN) mapping identifies the first lymph nodes to receive drainage from the primary tumor, and has been used to evaluate various tumors [4][5][6][7][8]. Minimally invasive treatment for EGC, such as ESD or local resection with SN biopsy under laparoscopy, has been evaluated in clinical studies, and the results will be available in the near future.…”

Section: Indications For Treatmentmentioning

confidence: 99%

Recent Advances in Endoscopic and Laparoscopic Management of Gastric Malignancy: A Literature Review

Kawahira¹,

Hayashi²,

Asano³

et al. 2013

J Gastrointest Dig Syst

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The current gold standard treatment for early gastric cancer (EGC) is en bloc resection with D2 lymph node dissection because GC tends to spread to the lymph nodes at an early stage. Endoscopic submucosal dissection (ESD) and laparoscopic gastrectomy may be considered as treatment options for EGC, depending on oncological stage. ESD provide local treatment only. Sentinel node (SN) mapping can indicate which nodes will be the first to be affected. Local resection of the primary lesion with SN biopsy would therefore be an ideal treatment for EGC. ESD followed by SN biopsy involve full-thickness resection of the gastric wall, and it is expected that they will be more commonly used for the treatment of appropriate stages of EGC in the near future.

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Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer

Cited by 61 publications

References 13 publications

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

Endoscopic resection of early gastric cancer

Recent Advances in Endoscopic and Laparoscopic Management of Gastric Malignancy: A Literature Review

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