J Gastric Cancer.  2010 Jun;10(2):49-54.

Expansion of Indication for Endoscopic SD in Early Gastric Cancer

• Kim DH
• Jung HY

Abstract

Endoscopic resection is now accepted as curative treatment modalities for early gastric cancer without lymph node metastasis. However, based on large-scaled data about the risk of lymph node metastasis in early gastric cancer and as a result of the technical development of endoscopic devices, it was suggested that the criteria for endoscopic resection should be extended. According to the treatment guidelines for gastric cancer in Japan, the extended indications include the following: differentiated-type mucosal cancer without ulceration and greater than 2 cm in diameter, differentiated-type mucosal cancer with ulceration and up to 3 cm in diameter, undifferentiated-type mucosal cancer without ulceration and up to 2 cm in diameter, and, in the absence of lymphovascular invasion, a tumor not deeper than submucosal level 1 (less than 500 micrometer). In this review, we discuss the evidence of the application of expanded endoscopic indication based on analysis of biologic behavior and data of endoscopic resection.

Keyword

Early gastric cancer; Endoscopic submucosal dissection; Expanded indication

MeSH Terms

Japan
Lymph Nodes
Neoplasm Metastasis
Stomach Neoplasms
Ulcer

Reference

1. Tada M, Murakami A, Karita M, Yanai H, Okita K. Endoscopic resection of early gastric cancer. Endoscopy. 1993. 25:445–450.

2. Takekoshi T, Baba Y, Ota H, Kato A, 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.

3. Kim SG. Endoscopic resection of early gastric cancer. Korean J Gastroenterol. 2009. 54:77–82.

4. Kanehara , editor. Treatment Guideline for Gastric Cancer in Japan. 2004. 2nd ed. Tokyo: Japanese Gastric Cancer Association.

5. 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.

6. Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand. 1965. 64:31–49.

7. Nakamura K, Sugano H, Takagi K. Carcinoma of the stomach in incipient phase: its histogenesis and histological appearances. Gann. 1968. 59:251–258.

8. Abe N, Watanabe T, Sugiyama M, Yanagida O, Masaki T, Mori T, et al. Endoscopic treatment or surgery for undifferentiated early gastric cancer? Am J Surg. 2004. 188:181–184.

9. 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.

10. 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.

11. Ye BD, Kim SG, Lee JY, Kim JS, Yang HK, Kim WH, et al. Predictive factors for lymph node metastasis and endoscopic treatment strategies for undifferentiated early gastric cancer. J Gastroenterol Hepatol. 2008. 23:46–50.

12. 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.

13. 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.

14. Tajima Y, Yamazaki K, Makino R, Nishino N, Aoki S, Kato M, et al. Gastric and intestinal phenotypic marker expression in early differentiated-type tumors of the stomach: clinicopathologic significance and genetic background. Clin Cancer Res. 2006. 12:6469–6479.

15. Kabashima A, Yao T, Maehara Y, Tsuneyoshi M. Relationship between biological behavior and phenotypic expression in undifferentiated-type gastric carcinomas. Gastric Cancer. 2005. 8:220–227.

16. Hyung WJ, Noh SH, Lee JH, Huh JJ, Lah KH, Choi SH, et al. Early gastric carcinoma with signet ring cell histology. Cancer. 2002. 94:78–83.

17. Kunisaki C, Shimada H, Nomura M, Matsuda G, Otsuka Y, Akiyama H. Therapeutic strategy for signet ring cell carcinoma of the stomach. Br J Surg. 2004. 91:1319–1324.

18. Maehara Y, Sakaguchi Y, Moriguchi S, Orita H, Korenaga D, Kohnoe S, et al. Signet ring cell carcinoma of the stomach. Cancer. 1992. 69:1645–1650.

19. Otsuji E, Yamaguchi T, Sawai K, Takahashi T. Characterization of signet ring cell carcinoma of the stomach. J Surg Oncol. 1998. 67:216–220.

20. Sugihara H, Hattori T, Fukuda M, Fujita S. Cell proliferation and differentiation in intramucosal and advanced signet ring cell carcinomas of the human stomach. Virchows Arch A Pathol Anat Histopathol. 1987. 411:117–127.

21. Akamatsu T, Katsuyama T. Histochemical demonstration of mucins in the intramucosal laminated structure of human gastric signet ring cell carcinoma and its relation to submucosal invasion. Histochem J. 1990. 22:416–425.

22. Takizawa K, Shimoda T, Nakanishi Y, Taniguchi H, Oda I, Gotoda T. Expanded indication for endoscopic resection from the pathological viewpoint-The possibility of sm invasion by undifferentiated-type Early Gastric Cancer. Stomach and Intestine. 2006. 41:9–17.

23. Li C, Kim S, Lai JF, Oh SJ, Hyung WJ, Choi WH, et al. Risk factors for lymph node metastasis in undifferentiated early gastric cancer. Ann Surg Oncol. 2008. 15:764–769.

24. Kim JH, Lee YC, Kim H, Song KH, Lee SK, Cheon JH, et al. Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc. 2009. 69:e1–e9.

25. Kang HY, Kim SG, Kim JS, Jung HC, Song IS. Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc. 2010. 24:509–516.

26. Namieno T, Koito K, Higashi T, Sato N, Uchino J. General pattern of lymph node metastasis in early gastric carcinoma. World J Surg. 1996. 20:996–1000.

27. Ohta H, Noguchi Y, Takagi K, Nishi M, Kajitani T, Kato Y. Early gastric carcinoma with special reference to macroscopic classifi cation. Cancer. 1987. 60:1099–1106.

28. Yasuda K, Shiraishi N, Suematsu T, Yamaguchi K, Adachi Y, Kitano S. Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma. Cancer. 1999. 85:2119–2123.

29. Son HJ, Song SY, Kim S, Noh JH, Sohn TS, Kim DS, et al. Characteristics of submucosal gastric carcinoma with lymph node metastatic disease. Histopathology. 2005. 46:158–165.

30. Oya M, Yao T, Nagai E, Tsuneyoshi M. Metastasizing intramucosal gastric carcinomas. Well differentiated type and proliferative activity using proliferative cell nuclear antigen and Ki-67. Cancer. 1995. 75:926–935.

31. Song SY, Park S, Kim S, Son HJ, Rhee JC. Characteristics of intramucosal gastric carcinoma with lymph node metastatic disease. Histopathology. 2004. 44:437–444.

32. Amano Y, Ishihara S, Amano K, Hirakawa K, Adachi K, Fukuda R, et al. An assessment of local curability of endoscopic surgery in early gastric cancer without satisfaction of current therapeutic indications. Endoscopy. 1998. 30:548–552.

33. Ishigami S, Hokita S, Natsugoe S, Tokushige M, Saihara T, Iwashige H, et al. Carcinomatous infiltration into the submucosa as a predictor of lymph node involvement in early gastric cancer. World J Surg. 1998. 22:1056–1059.

34. Kurihara N, Kubota T, Otani Y, Ohgami M, Kumai K, Sugiura H, et al. Lymph node metastasis of early gastric cancer with submucosal invasion. Br J Surg. 1998. 85:835–839.

35. Yamada H, Nihei Z, Yamashita T, Shirota Y, Ichikawa W, Sugihara K. Is lymphadenectomy needed for all submucosal gastric cancers? Eur J Surg. 2001. 167:199–203.

36. Park DJ, Lee HK, Lee HJ, Lee HS, Kim WH, Yang HK, et al. Lymph node metastasis in early gastric cancer with submucosal invasion: feasibility of minimally invasive surgery. World J Gastroenterol. 2004. 10:3549–3552.

37. Nakahara K, Tsuruta O, Tateishi H, Arima N, Takeda J, Toyonaga A, et al. Extended indication criteria for endoscopic mucosal resection of early gastric cancer with special reference to lymph node metastasis--examination by multivariate analysis. Kurume Med J. 2004. 51:9–14.

38. Gotoda T, Sasako M, Ono H, Katai H, Sano T, Shimoda T. Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer. Br J Surg. 2001. 88:444–449.

39. Tsuchiya A, Kikuchi Y, Ando Y, Yoshida T, Abe R. Lymph node metastases in gastric cancer invading the submucosal layer. Eur J Surg Oncol. 1995. 21:248–250.

40. Nishida T, Tanaka S, Haruma K, Yoshihara M, Sumii K, Kajiyama G. Histologic grade and cellular proliferation at the deepest invasive portion correlate with the high malignancy of submucosal invasive gastric carcinoma. Oncology. 1995. 52:340–346.