Minimally invasive and local treatment for mucosal early gastric cancer

Original article

Abstract

Background:

Early gastric cancer (EGC) can present an indication for local resection procedures under pertain circumstances. Especially endoscopic mucosal resections (EMRs) and laparoscopic resections or those combined with endoscopy have been made possible in recent years.

Methods:

From 1996 to 2004, of a total of 425 patients with gastric cancer, 58 patients with EGC (13.6%) were prospectively analyzed and observed. Of these, 35 patients had preoperatively diagnosed submucosal infiltration and subsequently underwent gastrectomy and standard lymphnodectomy. Of the 23 patients with intramucosal EGC, 22 underwent local resection. One patient displayed lymph node and liver metastasis at the time of diagnosis and received chemotherapy following staging laparoscopy.

Results:

Among the 23 patients with intramucosal EGC, 13 were female and 10 male. The average age of the patients was 77.4 years (range: 69–86). The rate of lymph node metastasis was 12.5% (n = 35) for submucosal EGC and 4.3% (n = 23) for intramucosal EGC. Twenty-two patients with intramucosal EGC underwent local resection (four EMR, six laparoscopic intragastric resection, 12 laparoscopic wedge resection). The average tumor size was 1.2 cm (range 0.3–2.3). The definitive histological findings yielded in all patients tumor-free resection margins without venous or lymphangic infiltration. In 10 of 18 patients undergoing laparoscopic resection a simultaneous sentinel lymph node sampling (4 ± 3 LN) was performed. There were no metastases detected. Method-specific complications did not occur. The morbidity of this patient group was 13.6% (three of 22). Mortality was zero. The average postoperative hospital stay was 6.5 days (range 2–12). In the median follow-up of 30.3 months (range 1–86) no recurrences have yet been diagnosed. Four patients died within the observation period of non-cancer–related causes.

Conclusions:

Minimally invasive local resection of intramucosal EGC represents a favorable option when strict determination of indication has taken place.

Keywords:

Early gastric cancer Laparoscopic local resection EMR 

References

  1. 1.
    Abe N, Sugiyama M, Masaki T, Ueki H, Yanagida O, Moril T, Watanabe T, Atomi Y (2004) Predictive factors for lymph node metastasis of differentiated submucosally invasive gastric cancer Gastrointest Endosc 60: 242–245CrossRefPubMedGoogle Scholar
  2. 2.
    Adachi Y, Shiraishi N, Kitano S (2002) Modern treatment of early gastric cancer: review of the Japanese experience Dig Surg 19: 333–339CrossRefPubMedGoogle Scholar
  3. 3.
    Avital S, Braseco O, Szomstein S, Liberman M, Rosenthal R (2003) Technical considerations in laparoscopic resection of gastric neoplasms Surg Endosc 17: 763–765CrossRefPubMedGoogle Scholar
  4. 4.
    Basili G, Nesi G, Barchielli A, Manetti A, Biliotti G (2003) Pathologic features and long-term results in early gastric cancer: report of 116 cases 8–13 years after surgery World J Surg 27: 149–152PubMedGoogle Scholar
  5. 5.
    Custureri F, D’Orazi V, Paparini N, Gabatel R, Urciuoli P, Patrizi G, Redler A, Di Matteo G (2004) Choice of the surgical treatment in early gastric cancer Hepatogastroenterology 51: 1210–1214PubMedGoogle Scholar
  6. 6.
    Gotoda T, Yanagiswaw A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers Gastric Cancer 3: 219–225PubMedGoogle Scholar
  7. 7.
    Hiki Y, Sakuramato S, Katada N, Shimano H (2000) Kombiniertes laparoskopisch-endoskopisches Vorgehen beim Magenkarzinom Chirurg 71: 1193–1201CrossRefPubMedGoogle Scholar
  8. 8.
    Kikuchi S, Katada N, Sakuramato S, Kobayashi N, Shimao H, Watanabe M, Hiki Y (2004) Survival after surgical treatment of early gastric cancer: surgical techniques and long term survival Langenbecks Arch Surg 389: 69–74CrossRefPubMedGoogle Scholar
  9. 9.
    Kim DY, Joo JK, Ryu SY, Kim YJ, Kim SK (2004) Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma World J Gastroenterol 10: 737–740PubMedGoogle Scholar
  10. 10.
    Kobayashi T, Kazui T, Kimura T (2003) Surgical local resection for early gastric cancer Surg Laparosc Endosc Percutan Tech 13: 299–304CrossRefPubMedGoogle Scholar
  11. 11.
    Ludwig K, Weiner R, Bernhardt J (2003) Minimal-invasive Resektion von Magentumoren Chirurg 74: 632–637CrossRefPubMedGoogle Scholar
  12. 12.
    Ludwig K, Wilhelm L, Scharlau U, Amtsberg G, Bernhardt J (2002) Laparoscopic–endoscopic combined resection of gastric tumours Surg Endosc 16: 1561–1565CrossRefPubMedGoogle Scholar
  13. 13.
    Matsumoto Y, Yanai H, Tokiyama H, Nishiaki M, Higaki S, Okita K (2000) Endoscopic ultrasonography for diagnosis of submucosal invasion in early gastric cancer J Gastroenterol 35: 326–331CrossRefPubMedGoogle Scholar
  14. 14.
    Nakagoe T, Tanaka K, Yasutake T, Sawai T, Tsuji T, Nanashima A, Shibasaki SI, Yamaguchi H, Ayabe H (2003) Long-term outcomes of intragastric endoscopic mucosal resection using a modified Buess technique for early gastric cancer Dig Surg 20: 141–147CrossRefPubMedGoogle Scholar
  15. 15.
    Ohashi S, Segava K, Okamura S, Mitake M, Urano H, Shimodaira M, Takeda T, Kanamori S, Naito T, Takeda K, Itih B, Goto H, Niwa Y, Hayakawa T (1999) The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer Gut 45: 599–604PubMedGoogle Scholar
  16. 16.
    Ohgami M, Otani Y, Kumai K, Kubota T, Kim Y, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience World J Surg 23: 187–193PubMedGoogle Scholar
  17. 17.
    Ono H, Kondo H, Gotada T, Shizao K, Yamaguchi H, Saito D, Hosohara K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer Gut 48: 225–229CrossRefPubMedGoogle Scholar
  18. 18.
    Rösch T, Kapfer B, Will U, Baronius W, Strobel M, Lorenz R, Ulm K (2002) Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study Scand J Gastroenterol 7: 856–862Google Scholar
  19. 19.
    Seto Y, Yamaguchi H, Shimoyama S, Shimizu N, Aoki F, Kaminishi M (2001) Results of local resection with regional lymphadenectomy for early gastric cancer Am J Surg 182: 498–501CrossRefPubMedGoogle Scholar
  20. 20.
    Willis S, Truong S, Gribnitz S, Fass J, Schumpelick V (2000) Endoscopic ultrasonography in the preoperative staging of gastric cancer Surg Endosc 14: 951–954CrossRefPubMedGoogle Scholar
  21. 21.
    Yanai H, Noguchi T, Mizumachi S, Tokiyama H, Nakamura H, Tada M, Okita K (1999) A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer Gut 44: 361–365PubMedGoogle Scholar
  22. 22.
    Yasuda K (2002) EUS in the detection of early gastric cancer Gastrointest Endosc 56(suppl 4): S68–75CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Department of SurgeryKlinikum Suedstadt RostockSuedringGermany
  2. 2.Department of RadiooncologyUniversity RostockSuedringGermany
  3. 3.Department of SurgeryKH SachsenhausenGermany

Personalised recommendations