Journal List > J Gastric Cancer > v.10(3) > 1076792

Lee and Kim: The Extended Indications of Endoscopic Submucosal Dissection (ESD) for Early Gastric Cancer Are Thus Not Entirely Safe

Abstract

Early gastric cancer (EGC) is defined as tumor invasion confined to the mucosa or submucosa, regardless of the presence of regional lymph node metastasis. Lymph node metastasis is the most powerful and important prognostic factor for gastric cancer. Based on the risk of lymph node metastasis in EGC obtained from a large number of surgical cases in Japan, it was suggested that the criteria for endoscopic mucosal resection (EMR) and endoscopic submucosal resection (ESD) as local treatment for EGC might be extended. However, extending the indications for EMR and ESD remains controversial because the long-term outcomes of these procedures have not been fully documented, and there is a risk for lymph node metastasis. Furthermore, current diagnostic imaging techniques are unsatisfactory for accurately predicting metastasis to lymph nodes. Moreover, the long-term results of standard radical gastrectomy including minimally invasive procedures for stage IA have been increasing and have reached 99 to 100%. To determine the true efficacy of endoscopic resection of EGC, we need more evidence of long-term follow-up, standardization of techniques, and pathological interpretation.

References

1. Korean Gastric Cancer Association. 2004 Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc. 2007. 7:47–54.
2. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000. 3:219–225.
crossref
3. Seto T, Nagawa H, Muto T. Impact of lymph node metastasis on survival with early gastric cancer. World J Surg. 1997. 21:186–189.
crossref
4. Isozaki H, Tanaka N, Okajima K. General and specific prognostic factors of early gastric carcinoma treated with curative surgery. Hepatogastroenterology. 1999. 46:1800–1808.
5. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006. 41:929–942.
crossref
6. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007. 10:1–11.
crossref
7. Ishikawa S, Togashi A, Inoue M, Honda S, Nozawa F, Toyama E, et al. Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type, depth of wall invasion, and lymph node metastasis. Gastric Cancer. 2007. 10:35–38.
crossref
8. Hölscher AH, Drebber U, Mönig SP, Schulte C, Vallböhmer D, Bollschweiler E. Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg. 2009. 250:791–797.
9. An JY, Baik YH, Choi MG, Noh JH, Sohn TS, Kim S. Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience. Ann Surg. 2007. 246:749–753.
crossref
10. Jee YS, Hwang SH, Rao J, Park DJ, Kim HH, Lee HJ, et al. Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines. Br J Surg. 2009. 96:1157–1161.
crossref
11. Song KY, Hyung WJ, Kim HH, Han SU, Cho GS, Ryu SW, et al. Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multi-center study. J Surg Oncol. 2008. 98:6–10.
crossref
12. Kim JJ, Lee JH, Jung HY, Lee GH, Cho JY, Ryu CB, et al. EMR for early gastric cancer in Korea: a multicenter retrospective study. Gastrointest Endosc. 2007. 66:693–700.
13. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009. 69:1228–1235.
crossref
14. Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009. 58:331–336.
crossref
15. Hwang SH, Park DJ, Jee YS, Kim MC, Kim HH, Lee HJ, et al. Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. Arch Surg. 2009. 144:559–564.
crossref
16. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007. 245:68–72.
crossref
17. Cai J, Ikeguchi M, Maeta M, Kaibara N. Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer. Surgery. 2000. 127:32–39.
crossref
18. Nakajo A, Natsugoe S, Ishigami S, Matsumoto M, Nakashima S, Hokita S, et al. Detection and prediction of micrometastasis in the lymph nodes of patients with pN0 gastric cancer. Ann Surg Oncol. 2001. 8:158–162.
crossref
19. Maehara Y, Oshiro T, Endo K, Baba H, Oda S, Ichiyoshi Y, et al. Clinical significance of occult micrometastasis in lymph nodes from patients with early gastric cancer who died of recurrence. Surgery. 1996. 119:397–402.
crossref
20. Harrison LE, Choe JK, Goldstein M, Meridian A, Kim SH, Clarke K. Prognostic significance of immunohistochemical micrometastasis in node negative gastric cancer patients. J Surg Oncol. 2000. 73:153–157.
crossref
21. Cai J, Ikeguchi M, Tsujitani S, Maeta M, Liu J, Kaibara N. Significant correlation between micrometastasis in the lymph nodes and reduced expression of E-cadherin in early gastric cancer. Gastric Cancer. 2001. 4:66–74.
crossref
22. Cai J, Ikeguchi M, Tsujitani S, MaetaM , Kaibara N. Micrometastasis in lymph nodes of mucosal gastric cancer. Gastric Cancer. 2000. 3:91–96.
crossref
23. Cho JY, Kim YS, Jung IS, Ryu CB, Lee MS, Shim CS, et al. Controversy concerning the cutoff value for depth of submucosal invasion after endoscopic mucosal resection of early gastric cancer. Endoscopy. 2006. 38:429–430.
crossref
24. Kim SH, Cho JY, Kim HG, Eun SH, Ko BM, Hong SJ, et al. The value of half stretching method of ESD specimen as interpretation of depth of tumor invasion: interim report. Korean J Gastrointest Endosc. 2007. 35:suppl 2. 117A.
25. Park DJ, Kim HH, Park YS, Lee HS, Lee WW, Lee HJ, et al. Simultaneous indocyanine green and 99mTc-antimony sulfur colloid-guided laparoscopic sentinel basin dissection for gastric cancer. Ann Surg Oncol. 2010. [Epub ahead of print].
26. Ichikura T, Sugasawa H, Sakamoto N, Yaguchi Y, Tsujimoto H, Ono S. Limited gastrectomy with dissection of sentinel node stations for early gastric cancer with negative sentinel node biopsy. Ann Surg. 2009. 249:942–947.
crossref
27. Adachi Y, Shiraishi N, Kitano S. Modern treatment of early gastric cancer: review of the Japanese experience. Dig Surg. 2002. 19:333–339.
crossref
28. Kiyama T, Mizutani T, Okuda T, Fujita I, Yamashita N, Ikeda K, et al. Laparoscopic surgery for gastric cancer: 5 years' experience. J Nippon Med Sch. 2006. 73:214–220.
crossref
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