Endoscopic and Surgical Treatment in Early Gastric Cancer: The Gray Zone in Treatment Decision-Making from the Perspectives of Endoscopists

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2025 Feb 26

PMID 40002197

Authors

Jun Yong Bae

Chang Beom Ryu

Moon Sung Lee

Stavros Dimitriadis

Affiliations

Soon will be listed here.

Abstract

To treat early gastric cancer, one must choose between endoscopic treatment and surgical treatment. Endoscopic treatment has been developing significantly since the late 1990s and has made great progress up to the present. However, many patients with early gastric cancer still undergo unnecessary surgery or endoscopic procedures. This is due to the existence of a "gray zone" of ambiguities between endoscopic and surgical treatment. These ambiguities arise because the important factors in determining the treatment for early gastric cancer can only be fully understood after endoscopic or surgical resection or because of discrepancies between the factors identifiable before treatment and those identifiable after treatment. This article aims to explore these ambiguous factors and discuss methods and efforts to reduce them.

References

Nakajima T . Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002; 5(1):1-5. DOI: 10.1007/s101200200000. View

. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2016; 20(1):1-19. PMC: 5215069. DOI: 10.1007/s10120-016-0622-4. View

. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2020; 24(1):1-21. PMC: 7790804. DOI: 10.1007/s10120-020-01042-y. View

Ono H, Yao K, Fujishiro M, Oda I, Uedo N, Nimura S . Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc. 2020; 33(1):4-20. DOI: 10.1111/den.13883. View

. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer. 2022; 26(1):1-25. DOI: 10.1007/s10120-022-01331-8. View

Kim Y, Kook M, Choi J, Lee J, Kim C, Eom B . Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval. J Gastric Cancer. 2020; 20(2):165-175. PMC: 7311219. DOI: 10.5230/jgc.2020.20.e14. View

Yamao T, Shirao K, Ono H, Kondo H, Saito D, Yamaguchi H . Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer. 1996; 77(4):602-6. DOI: 10.1002/(SICI)1097-0142(19960215)77:4<602::AID-CNCR3>3.0.CO;2-I. View

Kitagawa Y, Ishihara R, Ishikawa H, Ito Y, Oyama T, Oyama T . Esophageal cancer practice guidelines 2022 edited by the Japan esophageal society: part 1. Esophagus. 2023; 20(3):343-372. PMC: 10024303. DOI: 10.1007/s10388-023-00993-2. View

Maducolil J, Girgis S, Mustafa M, Gittens J, Fok M, Mahapatra S . Risk of tumour seeding in patients with liver lesions undergoing biopsy with or without concurrent ablation: meta-analysis. BJS Open. 2024; 8(3). PMC: 11094471. DOI: 10.1093/bjsopen/zrae050. View

10.

Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T . Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2002; 3(4):219-225. DOI: 10.1007/pl00011720. View

11.

. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14(2):113-23. DOI: 10.1007/s10120-011-0042-4. View

12.

Gao R, Wu B, Shen X, Peng T, Li D, Wei C . Overlooked risk for needle tract seeding following endoscopic ultrasound-guided minimally invasive tissue acquisition. World J Gastroenterol. 2020; 26(40):6182-6194. PMC: 7596640. DOI: 10.3748/wjg.v26.i40.6182. View

13.

Kwong W, Coyle W, Hasteh F, Peterson M, Savides T, Krinsky M . Malignant cell contamination may lead to false-positive findings at endosonographic fine needle aspiration for tumor staging. Endoscopy. 2014; 46(2):149-52. DOI: 10.1055/s-0033-1358922. View

14.

Yang S, Gu X, Tao R, Huo J, Hu Z, Sun F . Relationship between histological mixed-type early gastric cancer and lymph node metastasis: A systematic review and meta-analysis. PLoS One. 2022; 17(4):e0266952. PMC: 9012370. DOI: 10.1371/journal.pone.0266952. View

15.

Shim C, Chung H, Park J, Lee H, Shin S, Lee S . Early gastric cancer with mixed histology predominantly of differentiated type is a distinct subtype with different therapeutic outcomes of endoscopic resection. Surg Endosc. 2014; 29(7):1787-94. DOI: 10.1007/s00464-014-3861-7. View

16.

Yabuuchi Y, Takizawa K, Kakushima N, Kawata N, Yoshida M, Yamamoto Y . Discrepancy between endoscopic and pathological ulcerative findings in clinical intramucosal early gastric cancer. Gastric Cancer. 2021; 24(3):691-700. DOI: 10.1007/s10120-020-01150-9. View

17.

Yeomans N, Naesdal J . Systematic review: ulcer definition in NSAID ulcer prevention trials. Aliment Pharmacol Ther. 2008; 27(6):465-72. DOI: 10.1111/j.1365-2036.2008.03610.x. View

18.

Choi J, Kim S, Im J, Kim J, Jung H . Endoscopic estimation of tumor size in early gastric cancer. Dig Dis Sci. 2013; 58(8):2329-36. DOI: 10.1007/s10620-013-2644-7. View

19.

Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T . Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2019; 25(1):1-42. PMC: 6946738. DOI: 10.1007/s10147-019-01485-z. View

20.

Merga Z, Lee J, Gong C . Outcomes of Gastrectomy for Gastric Cancer in Patients Aged >80 Years: A Systematic Literature Review and Meta-Analysis. J Gastric Cancer. 2023; 23(3):428-450. PMC: 10412976. DOI: 10.5230/jgc.2023.23.e23. View