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A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

Takuji Gotoda|Waku Hatta|Tomoyuki Koike|Atsushi Masamune
거트앤리버 소화기연관학회협의회|2020.07|Gut and Liver|제14권 제4호|pp. 412-422|DOI 10.5009/gnl19194

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키워드

NeoplasmsEndoscopyStomachEndoscopic submucosal dissectionLymph nodes

초록

Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established.

Abstract

Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established.

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관련 논문AI추천

Long-Term Outcomes of Using Endoscopic Submucosal Dissection to Treat Early Gastric CancerNaohisa Yahagi, Toshihiro Nishizawa거트앤리버 소화기연관학회협의회 · Gut and Liver2018 · 제12권 제2호The Clinical Significance and Management of Noncurative Endoscopic Resection in Early Gastric Cancer허준, 전성우대한소화기내시경학회 · Clinical Endoscopy2013 · 제46권 제3호Long-Term Outcome of Extended Endoscopic Submucosal Dissection for Early Gastric Cancer with Differentiated Histology안지영, 정훤영대한소화기내시경학회 · Clinical Endoscopy2013 · 제46권 제5호Is Radical Surgery Necessary for All Patients Diagnosed as Having Non-Curative Endoscopic Submucosal Dissection?Byung Sam Park, Si Hyung Lee대한소화기내시경학회 · Clinical Endoscopy2019 · 제52권 제1호Endoscopic Submucosal Dissection of Early Gastric Cancer강기주, 김재학, 조주영, Byung-Hoon Min, Jae J. Kim, Jun Haeng Lee, Kyoung Mee Kim거트앤리버 소화기연관학회협의회 · Gut and Liver2011 · 제5권 제4호Clinical Outcomes of the Endoscopic Submucosal Dissection of Early Gastric Cancer Are Comparable between Absolute and New Expanded Criteria권중구, 김경옥, 김은수, 김은영, 박경식, 박정배, 박창근, 신근영, 양창헌, 이시형, 장병익, 전성우, 정윤진, 정진태, 조광범거트앤리버 소화기연관학회협의회 · Gut and Liver2015 · 제9권 제2호

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