Endoscopic and Surgical Treatment of Early Gastric Cancer

Abstract

Early gastric cancer (EGC) is defined as a tumor confined to the mucosa/submucosa, irrespective of the presence of lymph node metastases. Only high-quality endoscopic evaluation with chromoendoscopy and biopsy can increase the number of detected EGCs. As the presence of lymph node metastases has a strong adverse influence on patient prognosis, selected criteria must be used to identify the subset of lesions with no risk of lymphatic spread, as these are eligible for endoscopic resection. Conventional endoscopic mucosal resection has gained worldwide consensus for the treatment of selected EGC types but curative resection cannot be always guaranteed for lesions with a diameter > 15 mm. In these patients, a new technique, endoscopic submucosal dissection, allows successful en bloc resection. When conditions for endoscopic treatment cannot be met and lymphatic diffusion cannot be excluded, patients must be treated surgically. Gastrectomy with a clear margin of 2 cm from the lesion and D2 dissection is generally recommended as the treatment of choice. To define radicality and prognosis, the correct application of histological parameters is essential.