The value of diagnostic endoscopic submucosal dissection for patients with clinical submucosal invasive early gastric cancer

Fujiya, Keiichi; Takizawa, Kohei; Tokunaga, Masanori; Kawata, Noboru; Hikage, Makoto; Makuuchi, Rie; Takeda, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Tanaka, Masaki; Kakushima, Naomi; Ono, Hiroyuki; Terashima, Masanori

doi:10.1007/s10120-017-0724-7

Cited by 27 publications

(14 citation statements)

References 22 publications

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“…However, studies analyzing pathologic results of patients who underwent gastrectomy due to preoperatively suspected submucosal invasion reported that 28.8%-43.0% of these lesions could have been treated with endoscopic resection. 110,111 Therefore, further research is needed regarding treatment methods for preoperatively suspected submucosal invasive early gastric cancer.…”

Section: Statement G3: We Recommend Endoscopic Resection For Early Gamentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Section: Statement G3: We Recommend Endoscopic Resection For Early Gamentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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“…Some literature referred to the relationship between a waiting duration and the hardness of adhesion in repeat surgeries, while others suggested that this made the repeated surgery easier due to its loosening [6,7]. Furthermore, we have previously published that a wait time of fewer than 6 months may be acceptable in cStage I gastric cancer [8]. Performing surgery within this time may minimize associated surgical risks that arise from an adhesion.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic approach to early gastric cancer in a patient with a prior history of open right hepatectomy: a case report

et al. 2020

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Background: Laparoscopic gastrectomy is regarded a standard treatment procedure for early gastric cancer and is widely used in clinical practice. However, the feasibility of laparoscopic gastrectomy for patients with a prior history of open surgery, especially in the case of a complicated operation, remains unclear. Here, we report a laparoscopic gastrectomy case with a prior history of right hepatectomy. Case presentation: A 70-year-old man was diagnosed with early gastric cancers preceding a right hepatectomy for a solitary hepatocellular carcinoma at risk of rupture. An additional gastrectomy, after non-curative endoscopic submucosal dissection, was planned after the hepatectomy. Extensive adhesions were found around the liver. Rigid adherence of the duodenum to the adjacent hepatoduodenal ligament had formed. In addition, identification of the hepatic artery was difficult due to stiffening of the mesentery. Peeling off the adhesions from the ventral side of the duodenum revealed the supra-pyloric vessels and enabled us to transect the duodenum safely. Further, exposing the proper hepatic artery via the dorsal side of the mesentery and subsequent supra-pancreatic dissection on the outermost layer allowed effective identification of the right gastric artery. The postoperative course was uneventful. Conclusions: We successfully performed total laparoscopic distal gastrectomy on a patient with a prior history of major hepatectomy.

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“…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. In 2017, the concept of diagnostic ESD was proposed for clinically submucosal invasive EGC . In that study, Fujiya et al compared the overall survival (OS) and cause‐specific survival (CSS) between patients undergoing ESD and a radical gastrectomy for clinically diagnosed differentiated EGC with SM1 invasion and of 3 cm in diameter or smaller.…”

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 99%

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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The value of diagnostic endoscopic submucosal dissection for patients with clinical submucosal invasive early gastric cancer

Abstract: The stomach was preserved in 28.8% of patients, and preceding ESD did not show obvious disadvantages. Therefore, diagnostic ESD should be considered as an initial treatment for limited cT1b gastric cancer cases.

Cited by 27 publications

References 22 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Laparoscopic approach to early gastric cancer in a patient with a prior history of open right hepatectomy: a case report

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

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