Korean J Gastroenterol.  2017 Sep;70(3):128-133. 10.4166/kjg.2017.70.3.128.

Treatment Strategies after Non-curative Endoscopic Resection of Early Gastric Cancer

• Kim SH
• Hong SJ

• KMID: 2390790
• DOI: http://doi.org/10.4166/kjg.2017.70.3.128

Abstract

The cases of non-curative endoscopic resection (NCR) of early gastric cancer have increased due to the widespread use of endoscopic submucosal dissection (ESD). NCR is associated with augmenting chances of local recurrence and lymph node metastasis (LNM). Therefore, some additional treatment strategies after NCR are needed. Treatment strategies for NCR should be determined by considering the risk of residual tumor or local recurrence and LNM. Additional surgical treatment such as gastrectomy and lymph node dissection are recommended in patients who have high-risk of LNM. Close observation without additional treatment is considered for selected patients with a less possibility of local recurrence or LNM. Also it may be suggested if there is no or less benefit from surgery in elderly patients or patients with underlying diseases. Additional endoscopic procedures including ESD, endoscopic mucosal resection or argon coagulation therapy are suggested alternatively for highly selected patients not at risk of LNM based on the absolute or expanded criteria of ESD.

Keyword

Gastric cancers; Endoscopic submucosal dissection; Residual tumors; Lymphatic metastasis; Therapeutics

MeSH Terms

Aged
Argon
Gastrectomy
Humans
Lymph Node Excision
Lymph Nodes
Lymphatic Metastasis
Neoplasm Metastasis
Neoplasm, Residual
Recurrence
Stomach Neoplasms*
Argon

Figure

• 

  Fig. 1. Algorithm for treatment strategies after non-curative resection of early gastric cancer (This figure was modified and created with reference to Japanese gastric cancer treatment guidelines 2014 [ver.4]).4 a It can be performed selectively for patients who want to preserve remnant stomach; b It can be performed selectively for patients who have difficulty in endoscopic resection or want to preserve remnant stomach. pT1a, tumor invades muscularis mucosa; pT1b (SM1), tumor invades submucosa, <500 µm from the muscularis mucosa; APC, argon plasma coagulation; EFTR, endoscopic full-thickness resection; LLND, laparoscopic lymph node dissection.

Reference

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