J Gastric Cancer.  2014 Mar;14(1):7-14.

Endoscopic Resection for Early Gastric Cancer beyond Absolute Indication with Emphasis on Controversial Issues

Affiliations
  • 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. stomachlee@gmail.com

Abstract

Endoscopic resection is the established treatment for early gastric cancer in selected patients with negligible risk of lymph node metastasis ('absolute indication'). Based on clinical observations and large pathological databases, expanding indications for endoscopic resection beyond absolute indication has been tried in Japan and Korea. However, controversies exist regarding the safety of treating early gastric cancer beyond absolute indication in terms of pathological evaluation of the resected specimen, definition of expanded indication, discrepancy between pre-endoscopic resection and post-endoscopic resection diagnoses of gastric neoplasm, and the best strategy for cases with non-curative resection. In this brief review, current evidence and clinical experience regarding issues of endoscopic resection beyond absolute indication will be summarized.

Keyword

Stomach neoplasm; Endoscopic gastrointestinal surgical procedures

MeSH Terms

Diagnosis
Endoscopy, Gastrointestinal
Humans
Japan
Korea
Lymph Nodes
Neoplasm Metastasis
Stomach Neoplasms*

Reference

1. Bertuccio P, Chatenoud L, Levi F, Praud D, Ferlay J, Negri E, et al. Recent patterns in gastric cancer: a global overview. Int J Cancer. 2009; 125:666–673.
Article
2. Lee KS, Oh DK, Han MA, Lee HY, Jun JK, Choi KS, et al. Gastric cancer screening in Korea: report on the national cancer screening program in 2008. Cancer Res Treat. 2011; 43:83–88.
Article
3. Hamashima C, Shibuya D, Yamazaki H, Inoue K, Fukao A, Saito H, et al. The Japanese guidelines for gastric cancer screening. Jpn J Clin Oncol. 2008; 38:259–267.
Article
4. Takekoshi T, Baba Y, Ota H, Kato Y, Yanagisawa A, Takagi K, et al. Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases. Endoscopy. 1994; 26:352–358.
Article
5. Uedo N, Iishi H, Tatsuta M, Ishihara R, Higashino K, Takeuchi Y, et al. Longterm outcomes after endoscopic mucosal resection for early gastric cancer. Gastric Cancer. 2006; 9:88–92.
Article
6. Kojima T, Parra-Blanco A, Takahashi H, Fujita R. Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc. 1998; 48:550–554. discussion 554-555.
Article
7. Horiki N, Omata F, Uemura M, Suzuki S, Ishii N, Fukuda K, et al. Risk for local recurrence of early gastric cancer treated with piecemeal endoscopic mucosal resection during a 10-year follow-up period. Surg Endosc. 2012; 26:72–78.
Article
8. Song JH, Kim JJ, Lee JH, Min BH, Yang S, Park SS, et al. Clinical characteristics and lymph node status in the patients with gastrectomy after endoscopic mucosal resection for early gastric cancer. Korean J Helicobacter Up Gastrointest Res. 2007; 7:13–19.
9. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006; 64:877–883.
Article
10. 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.
Article
11. Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol. 2005; 23:4490–4498.
Article
12. Arigami T, Uenosono Y, Yanagita S, Nakajo A, Ishigami S, Okumura H, et al. Clinical significance of lymph node micrometastasis in gastric cancer. Ann Surg Oncol. 2013; 20:515–521.
Article
13. Maehara Y, Oshiro T, Endo K, Baba H, Oda S, Ichiyoshi Y, et al. Clinical significance of occult micrometastasis lymph nodes from patients with early gastric cancer who died of recurrence. Surgery. 1996; 119:397–402.
Article
14. Akagi T, Shiraishi N, Kitano S. Lymph node metastasis of gastric cancer. Cancers (Basel). 2011; 3:2141–2159.
Article
15. Morgagni P, Saragoni L, Scarpi E, Zattini PS, Zaccaroni A, Morgagni D, et al. Lymph node micrometastases in early gastric cancer and their impact on prognosis. World J Surg. 2003; 27:558–561.
Article
16. Cao L, Hu X, Zhang Y, Huang G. Adverse prognosis of clustered-cell versus single-cell micrometastases in pN0 early gastric cancer. J Surg Oncol. 2011; 103:53–56.
Article
17. 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. author reply 430.
Article
18. Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer. 2009; 12:148–152.
Article
19. Kang HJ, Kim DH, Jeon TY, Lee SH, Shin N, Chae SH, et al. Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection. Gastrointest Endosc. 2010; 72:508–515.
Article
20. Park WY, Shin N, Kim JY, Jeon TY, Kim GH, Kim H, et al. Pathologic definition and number of lymphovascular emboli: impact on lymph node metastasis in endoscopically resected early gastric cancer. Hum Pathol. 2013; 44:2132–2138.
Article
21. Kim JY, Kim WG, Jeon TY, Kim GH, Jeong EH, Kim DH, et al. Lymph node metastasis in early gastric cancer: evaluation of a novel method for measuring submucosal invasion and development of a nodal predicting index. Hum Pathol. 2013; 44:2829–2836.
Article
22. Mita T, Shimoda T. Risk factors for lymph node metastasis of submucosal invasive differentiated type gastric carcinoma: clinical significance of histological heterogeneity. J Gastroenterol. 2001; 36:661–668.
Article
23. Hanaoka N, Tanabe S, Mikami T, Okayasu I, Saigenji K. Mixed-histologic-type submucosal invasive gastric cancer as a risk factor for lymph node metastasis: feasibility of endoscopic submucosal dissection. Endoscopy. 2009; 41:427–432.
Article
24. Sugano H, Nakamura K, Kato Y. Pathological studies of human gastric cancer. Acta Pathol Jpn. 1982; 32:Suppl 2. 329–347.
25. Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc. 2011; 74:485–493.
Article
26. Ohnita K, Isomoto H, Shikuwa S, Yajima H, Minami H, Matsushima K, et al. Early and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in a large patient series. Exp Ther Med. 2014; 7:594–598.
Article
27. Gotoda T, Kaltenbach T, Soetikno R. Is en bloc resection essential for endoscopic resection of GI neoplasia? Gastrointest Endosc. 2008; 67:805–807.
Article
28. 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.
Article
29. Lee JH, Kim JG, Jung HK, Kim JH, Jeong WK, Jeon TJ, et al. Synopsis on clinical practice guideline of gastric cancer in Korea: an evidence-based approach. Korean J Gastroenterol. 2014; 63:66–81.
Article
30. Nasu J, Nishina T, Hirasaki S, Moriwaki T, Hyodo I, Kurita A, et al. Predictive factors of lymph node metastasis in patients with undifferentiated early gastric cancers. J Clin Gastroenterol. 2006; 40:412–415.
Article
31. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.
32. Park YD, Chung YJ, Chung HY, Yu W, Bae HI, Jeon SW, et al. Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach. Endoscopy. 2008; 40:7–10.
Article
33. Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, et al. Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy. 2012; 44:122–127.
Article
34. Kim YY, Jeon SW, Kim J, Park JC, Cho KB, Park KS, et al. Endoscopic submucosal dissection for early gastric cancer with undifferentiated histology: could we extend the criteria beyond? Surg Endosc. 2013; 27:4656–4662.
Article
35. Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Odagaki T, et al. Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Endoscopy. 2013; 45:703–707.
Article
36. Choi J, Kim SG, Im JP, Kim JS, Jung HC, Song IS. Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer. Endoscopy. 2010; 42:705–713.
Article
37. Sawada S, Fujisaki J, Yamamoto N, Kato Y, Ishiyama A, Ueki N, et al. Expansion of indications for endoscopic treatment of undifferentiated mucosal gastric cancer: analysis of intramucosal spread in resected specimens. Dig Dis Sci. 2010; 55:1376–1380.
Article
38. Nagahama T, Yao K, Maki S, Yasaka M, Takaki Y, Matsui T, et al. Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video). Gastrointest Endosc. 2011; 74:1259–1267.
Article
39. Cho SJ, Choi IJ, Kim CG, Lee JY, Kook MC, Park S, et al. Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification. Endoscopy. 2011; 43:465–471.
Article
40. Kato M, Nishida T, Tsutsui S, Komori M, Michida T, Yamamoto K, et al. Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group. J Gastroenterol. 2011; 46:325–331.
Article
41. 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.
Article
42. Park CH, Shin S, Park JC, Shin SK, Lee SK, Lee YC, et al. Long-term outcome of early gastric cancer after endoscopic submucosal dissection: expanded indication is comparable to absolute indication. Dig Liver Dis. 2013; 45:651–656.
Article
43. Ryu KW, Choi IJ, Doh YW, Kook MC, Kim CG, Park HJ, et al. Surgical indication for non-curative endoscopic resection in early gastric cancer. Ann Surg Oncol. 2007; 14:3428–3434.
Article
44. Noh H, Park JJ, Yun JW, Kwon M, Yoon DW, Chang WJ, et al. Clinicopathologic characteristics of patients who underwent curative additional gastrectomy after endoscopic submucosal dissection for early gastric cancer or adenoma. Korean J Gastroenterol. 2012; 59:289–295.
Article
45. Bae SY, Jang TH, Min BH, Lee JH, Rhee PL, Rhee JC, et al. Early additional endoscopic submucosal dissection in patients with positive lateral resection margins after initial endoscopic submucosal dissection for early gastric cancer. Gastrointest Endosc. 2012; 75:432–436.
Article
46. Han JP, Hong SJ, Kim HK, Ko BM, Lee MS. Long-term outcomes of noncurative resection after endoscopic submucosal dissection for early gastric cancer. In : 63rd Congress of the Korean Society of Gastrointestinal Endoscopy; 2013 Dec 23; Sheraton Grande Wolkerhill Hotel. Seoul: Korean Society of Gastrointestinal Endoscopy;2013. p. 92.
47. Kim ER, Min BH, Kim KM, Park CK, Min YW, Rhee PL, et al. Long-term outcomes of noncurative resection of early gastric cancer. In : 63rd Congress of the Korean Society of Gastrointestinal Endoscopy; 2013 Dec 23; Sheraton Grande Wolkerhill Hotel. Seoul: Korean Society of Gastrointestinal Endoscopy;2013. p. 92.
48. Yang HJ, Kim SG, Lim JH, Choi J, Im JP, Kim JS, et al. Predictors of lymph node metastasis and residual tumor in non-curative endoscopic resection of early gastric cancer. In : 63rd Congress of the Korean Society of Gastrointestinal Endoscopy; 2013 Dec 23; Sheraton Grande Wolkerhill Hotel. Seoul: Korean Society of Gastrointestinal Endoscopy;2013. p. 96.
49. Lee JH, Hong SJ, Jang JY, Kim SE, Seol SY. Outcome after endoscopic submucosal dissection for early gastric cancer in Korea. World J Gastroenterol. 2011; 17:3591–3595.
50. Gotoda T, Iwasaki M, Kusano C, Seewald S, Oda I. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg. 2010; 97:868–871.
51. Choi MK, Kim GH, Park do Y, Song GA, Kim DU, Ryu DY, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience. Surg Endosc. 2013; 27:4250–4258.
52. Lee H, Yun WK, Min BH, Lee JH, Rhee PL, Kim KM, et al. A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc. 2011; 25:1985–1993.
53. Kosaka T, Endo M, Toya Y, Abiko Y, Kudara N, Inomata M, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Dig Endosc. 2014; 26:183–191.
Full Text Links
  • JGC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr