The incidence of lymph node metastasis in early gastric cancer according to the expanded criteria in comparison with the absolute criteria of the Japanese Gastric Cancer Association: a systematic review of the literature and meta-analysis

Abdelfatah, Mohamed M.; Barakat, Mohamed; Lee, Hyuk; Kim, Jae J.; Uedo, Noriya; Grimm, Ian S.; Othman, Mohamed O.

doi:10.1016/j.gie.2017.09.025

Cited by 119 publications

(106 citation statements)

References 53 publications

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“…And the expanded indications include mucosal differentiated EGC sized >2 cm without ulceration, intramucosal differentiated EGC of <3 cm in diameter with ulceration, and intramucosal undifferentiated EGC of ≤2 cm in diameter. An extremely low risk of LNM for lesions without lymphovascular infiltration has then been confirmed . The indications of EGC for endoscopic resection may be reasonably expanded.…”

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 86%

“…Another study reported that men with mucosal undifferentiated EGC of ≤2 cm in size and no lymphatic involvement had a high risk of LNM, and 3.2% of patients who were negative for all identified risk factors had LNM . A meta‐analysis pooling the LNM rate of undifferentiated EGC found that compared with the absolute standard, the incidence of LNM in undifferentiated mucosal lesions of no more than 2 cm was significantly higher ( P = 0.0004) . Therefore, similar to differentiated lesions with SM1 invasion sized <3 cm, endoscopic indications for these lesions should be assessed considering the risk related to surgery due to an increased risk of LNM.…”

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 98%

“…To solve the discrepancy of the LNM rate in different studies, a meta‐analysis was recently performed to investigate whether EGC diagnosed according to the expanded criteria had a higher risk of LNM than those met the absolute criteria . The results showed that the incidence of LNM in differentiated lesions <3 cm with SM1 invasion was significantly higher than that of the absolute standard ( P = 0.004), indicating that SM1‐invasive differentiated EGC should be balanced against the risks related to surgery due to their increased risk of LNM.…”

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 99%

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Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Zhang

Gao

et al. 2019

J of Digest Diseases

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With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow-up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level-C1 EGC. For patients with a level-C2 EGC, close follow-up is suggested for low-risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes. K E Y W O R D Scurative resection, early gastric cancer, eCura system, endoscopy, gastric neoplasms, surveillance

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Section: Endoscopic Resection Indications For Egcmentioning

confidence: 86%

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 98%

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Zhang

Gao

et al. 2019

J of Digest Diseases

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“…Other independent risk factors for nodal metastasis include tumor size >3.0 cm, submucosal invasion (both superficial and deep), poor differentiation, and mixed intestinal adenocarcinomas with poorly cohesive carcinoma . A recent meta‐analysis of risk factors of EGC in 12 qualifying studies shows a very low incidence of lymph node metastasis for intramucosal intestinal EGC ≤3.0 cm with ulceration (0.57%; RR 3.01) or EGC without ulceration, regardless of tumor size (0.27%; RR 1.69); but for poorly differentiated EGC ≤2.0 cm and intestinal EGC <3.0 cm with slight submucosal invasion (superficial) the incidence of nodal metastasis is significantly higher (2.6%, RR 6.79 and 2.5%, RR 6.30, respectively) . Therefore, these investigators concluded that expanding the indications of endoscopic resection to poorly differentiated EGC ≤2.0 cm in size and intestinal EGC with superficial submucosal invasion should be done with caution because of the significantly higher risk of nodal metastasis .…”

Section: Group 3: Early Gastric Carcinoma Of the Antrum‐pylorusmentioning

confidence: 99%

“…A recent meta‐analysis of risk factors of EGC in 12 qualifying studies shows a very low incidence of lymph node metastasis for intramucosal intestinal EGC ≤3.0 cm with ulceration (0.57%; RR 3.01) or EGC without ulceration, regardless of tumor size (0.27%; RR 1.69); but for poorly differentiated EGC ≤2.0 cm and intestinal EGC <3.0 cm with slight submucosal invasion (superficial) the incidence of nodal metastasis is significantly higher (2.6%, RR 6.79 and 2.5%, RR 6.30, respectively) . Therefore, these investigators concluded that expanding the indications of endoscopic resection to poorly differentiated EGC ≤2.0 cm in size and intestinal EGC with superficial submucosal invasion should be done with caution because of the significantly higher risk of nodal metastasis . It must be emphasized that most studies on the risk factors of nodal metastasis in EGC focus on EGC in the distal stomach, which includes tumors in both the antrum‐pylorus and the corpus.…”

Section: Group 3: Early Gastric Carcinoma Of the Antrum‐pylorusmentioning

confidence: 99%

Emerging evidence supports grouping by location of early gastric carcinoma for appropriate clinical management in Chinese patients

Huang

et al. 2018

J of Digest Diseases

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Gastric cancer is common in China. At present, early detection with prompt resection of early gastric carcinoma (EGC) is crucial for improving patient's survival. Because of high heterogeneity of EGC in Chinese patients we reviewed recent clinicopathological and molecular evidence and proposed a grouping EGC in three subgroups according to their location for appropriate management. In group 1 (cardia), most patients with EGC in this small location were elderly men. The tumors originated in the cardiac mucosa with a high proportion of cases with slightly elevated gross patterns and intestinal adenocarcinoma histology with moderate to well differentiation. Poorly cohesive carcinoma was infrequent. As the risk for lymph node metastasis in this kind of tumor was significantly lower than that in the distal stomach, endoscopic therapy is preferred. Group 2 (fundus‐corpus), many patients with EGC in this large location were young women. The EGCs originated in the oxyntic mucosa with pure and mixed poorly cohesive carcinomas that are more commonly present in this area than in any other. Most tumors were poorly differentiated with a high risk for lymph node metastasis. Thus, endoscopic therapy may be appropriate for intramucosal, but not for submucosal, carcinoma. Group 3 (antrum‐pylorus). EGC tumors arose from the antral mucosa, primarily because of Helicobacter pylori infection, following the Correa gastric cancer tumorigenetic pathway. Erosive and ulcerated gross patterns were most frequently observed. While most EGCs in this location were mainly intestinal adenocarcinomas, poorly differentiated EGCs were substantial in number. Because the risk of lymph node metastasis remains to be illustrated, clinical management requires an individualized approach. This preliminary observation requires verification in large nationwide multicenter studies.

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Surgical Management of Gastric Cancer

2022

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he incidence of gastric cancer has decreased worldwide since the 1970s owing to factors such as improved refrigeration 1 and effective therapy against Helicobacter pylori. 2 However, prognosis for patients with gastric cancer has only modestly improved during this time, probably because patients often present with advanced disease. In the US, up to 65% of patients present with stage III or IV disease, and even in countries like Japan with robust screening programs, half of patients still present with advanced disease. 3 As a result, gastric cancer remains the third most common cause of cancer mortality worldwide, 4 and in the US, there are still 27 000 new cases and 11 000 deaths each year. 5 Treatment of gastric cancer requires a multidisciplinary approach and continues to evolve. Here, we review the contemporary surgical management of all stages of gastric cancer. Early Gastric CancerEarly gastric cancer (EGC) is defined as a tumor limited to the mucosa or submucosa (clinical T1) regardless of lymph node status. 6 The risk of lymph node involvement dictates the subsequent management of EGCs. Endoscopic TherapyGastric cT1a tumors that are less than 2 cm in diameter, lack ulceration with differentiated histology, have no lymphovascular inva-sion, and lack clinical evidence of locoregional lymph node involvement have a low 1% to 5% risk of lymph node metastasis. 7,8 Patients with these tumors are thus candidates for curative-intent endoscopic therapy with either endoscopic mucosal resection or endoscopic submucosal dissection. 9,10 Although a propensity scorematched analysis of data from the National Cancer Database found that gastrectomy was associated with superior survival compared with endoscopic resection for cT1a tumors, it is unclear what proportion of these tumors met the other criteria for endoscopic resection. 8 Furthermore, other Eastern and Western series have reported excellent long-term outcomes after endoscopic resection in appropriately selected patients, 9,10 and currently the Japanese Gastric Cancer Association, 11 European Society of Medical Oncology, 12 and National Comprehensive Cancer Network (NCCN) 13 all recommend endoscopic therapy as initial therapy for EGC meeting the previously mentioned criteria. All patients with gastric cancer should undergo H pylori testing and eradication therapy if test results are positive, but this is especially important for patients with EGC who are undergoing endoscopic resection, as H pylori eradication decreases the risk of developing metachronous gastric cancers. 14 In contrast, gastric cT1b tumors have nodal metastasis rates of 18% to 32%, 8,15 and a radical gastrectomy (ie, one that includes a formal lymphadenectomy) should be considered for patients with these tumors. Patients who undergo noncurative endoscopic resection, ie, those with positive margins, lymphovascular invasion, or poorly differentiated histology on final pathology, also have a 14% IMPORTANCE Surgery plays a critical role in the management of all stages of gastric cancer.OBSERVATIONS Fo...

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The incidence of lymph node metastasis in early gastric cancer according to the expanded criteria in comparison with the absolute criteria of the Japanese Gastric Cancer Association: a systematic review of the literature and meta-analysis

Cited by 119 publications

References 53 publications

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Emerging evidence supports grouping by location of early gastric carcinoma for appropriate clinical management in Chinese patients

Surgical Management of Gastric Cancer

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