A New Clinical Model for Prediction of Nodal Metastasis for Patients with Early Gastric Cancer: Is this Good Enough?

Excerpt

Early gastric cancer (EGC), an entity that was first recognized in 1962 by the Japanese Society of Gastroenterological Endoscopy, refers specifically to gastric cancer that is confined to the mucosa (T₁a) or submucosa (T₁b) layer irrespective of lymph node involvement.1 Such a distinction was established based on the observation that patients with EGC have an excellent prognosis after conventional gastrectomy with standardized lymph node dissection. Although nodal status does not affect the designation of EGC, lymph node metastasis is one of the most important prognostic factor.2 As a result, gastrectomy with regional lymphadenectomy remained the gold standard for treatment of EGC.3 However, radical gastrectomy with standard D2 nodal dissection is associated with significant risks of morbidity and mortality, and further compromises patients’ quality of life.4 Endoscopic resection emerged as a highly attractive alternative, because it preserves the stomach and averts all the complications associated with gastrectomy.5 Because endoscopic resection provides only local treatment without lymph node dissection, it should only be performed for EGC with absence of nodal metastases. …