Early gastric cancer: A challenge in Western countries

Abstract

Early gastric cancer (EGC) is an invasive carcinoma involving only the stomach mucosa or submucosa, independently of lymph node status. EGC represents over 50% of cases in Japan and in South Korea, whereas it accounts only for approximately 20% of all newly diagnosed gastric cancers in Western countries. The main classification systems of EGC are the Vienna histopathologic classification and the Paris endoscopic classification of polypoid and non-polypoid lesions. A careful endoscopic assessment is fundamental to establish the best treatment of EGC. Generally, EGCs are curable if the lesion is completely removed by endoscopic resection or surgery. Some types of EGC can be resected endoscopically; for others the most appropriate treatment is surgical resection and D2 lymphadenectomy, especially in Western countries. The favorable oncological prognosis, the extended lymphadenectomy and the reconstruction of the intestinal continuity that excludes the duodenum make the prophylactic cholecystectomy mandatory to avoid the onset of biliary complications.

Keywords: Diagnosis; Early gastric cancer; Endoscopic resection; Lymph nodes metastases; Surgery; Treatment.

Figure 1

Lymph node removal along the upper border of the pancreas (lymph node station N. 12a) (A), along the common hepatic artery (lymph node station N. 8a) and along the left gastric artery (lymph node station N. 9) (B). Personal experience: Consecutive patients were recruited by senior surgeons (MMC, GB).