Treatment Strategies after Noncurative Endoscopic Resection of Early Gastric Cancer

Shin Hee Kim; Su Jin Hong

doi:10.4166/kjg.2017.70.3.128

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Kim and Hong: Treatment Strategies after Noncurative Endoscopic Resection of Early Gastric Cancer

Review Article

Korean J Gastroenterol 2017;70(3):128-133.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.3.128

Treatment Strategies after Noncurative Endoscopic Resection of Early Gastric Cancer

Shin Hee Kim, Su Jin Hong

Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea

Correspondence to: Su Jin Hong, Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea. Tel: +82-32-621-5094, Fax: +82-32-621-5080, E-mail: sjhong@schmc.ac.kr

Received 8 August 2017 Revised 16 September 2017 Accepted 18 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The cases of non-curative endoscopic resection (NCR) of early gastric cancer have increased due to the widespread use of endoscopic submucosal dissection (ESD). NCR is associated with augmenting chances of local recurrence and lymph node metastasis (LNM). Therefore, some additional treatment strategies after NCR are needed. Treatment strategies for NCR should be determined by considering the risk of residual tumor or local recurrence and LNM. Additional surgical treatment such as gastrectomy and lymph node dissection are recommended in patients who have high-risk of LNM. Close observation without additional treatment is considered for selected patients with a less possibility of local recurrence or LNM. Also it may be suggested if there is no or less benefit from surgery in elderly patients or patients with underlying diseases. Additional endoscopic procedures including ESD, endoscopic mucosal resection or argon coagulation therapy are suggested alternatively for highly selected patients not at risk of LNM based on the absolute or expanded criteria of ESD.

Keywords: Gastric cancers, Endoscopic submucosal dissection, Residual tumors, Lymphatic metastasis, Therapeutics

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Fig. 1.

Algorithm for treatment strategies after non-curative resection of early gastric cancer (This figure was modified and created with reference to Japanese gastric cancer treatment guidelines 2014 [ver.4]).⁴ ^a It can be performed selectively for patients who want to preserve remnant stomach; ^b It can be performed selectively for patients who have difficulty in endoscopic resection or want to preserve remnant stomach. pT1a, tumor invades muscularis mucosa; pT1b (SM1), tumor invades submucosa, <500 µm from the muscularis mucosa; APC, argon plasma coagulation; EFTR, endoscopic full-thickness resection; LLND, laparoscopic lymph node dissection.

Table 1.

Definition of Curative Resection

Curative resection: fulfill all of the following conditions

En bloc resection tumor size ≤2 cm

Histologically of differentiated type

pT1a

HM0

VM0

Ly (−)

V (−)

Curative resection for tumors of expanded indication: fulfill all of the following conditions

En bloc resection, HM0, VM0, Ly (−), V (−) and

(a) Tumor size >2 cm, histologically of differentiated type, pT1a, ulcer (−)

(b) Tumor size ≤3 cm, histologically of differentiated type, pT1a, ulcer (+)

(d) Tumor size ≤3 cm, histologically of differentiated type, pT1b (SM1)

This table was modified with reference to Japanese gastric cancer treatment guidelines 2014 (ver. 4).⁴ pT1a, Tumor invades muscularis mucosa; pT1b (SM1), Tumor invades submucosa, <500 µm from the muscularis mucosa; HM0, Negative horizontal margin; VM0, Negative vertical margin; Ly, Lymphatic infiltration; V, Vascular infiltration.

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