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Present situation of minimally invasive surgical treatment for early gastric cancer

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1154-1165页

作者： Chun-Yan Li Yi-Feng Wang Li-Kang Luo Xiao-Jun Yang The First Clinical Medical School Lanzhou UniversityLanzhou 730000Gansu ProvinceChina The First Clinical Medicine College Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina General Surgery Clinical Centre Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina The Second Department of General Surgery Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Lanzhou University People's Clinical Hospital Lanzhou 730000Gansu ProvinceChina Gansu Research Center of Prevention and Control Project for Digestive Oncology Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina

Minimally invasive surgery is a kind of surgical operation,which is performed by using professional surgical instruments and equipment to inactivate,resect,repair or reconstruct the pathological changes,deformities and wounds in human body through micro-trauma or micro-approach,in order to achieve the goal of treatment,its surgical effect is equivalent to the traditional open surgery,while avoiding the morbidity of conventional surgical *** addition,it also has the advantages of less trauma,less blood loss during operation,less psychological burden and quick recovery on patients,and these minimally invasive techniques provide unique value for the examination and treatment of gastric cancer *** minimally invasive surgical techniques have developed rapidly and offer numerous options for the treatment of early gastric cancer(EGC):endoscopic mucosal resection(EMR),underwater EMR(UEMR),endoscopic submucosal dissection(ESD),endoscopic full-thickness resection(EFTR),endoscopic submu-cosal excavation(ESE),submucosal tunnel endoscopic resection,laparoscopic and endoscopic cooperative surgery(LECS);Among them,EMR,EFTR and LECS technologies have a wide range of applications and different modific-ations have been derived from their respective surgical operations,such as band-assisted EMR(BA-EMR),conven-tional EMR(CEMR),over-the-scope clip-assisted EFTR,no-touch EFTR,the inverted LECS,closed LECS,and so *** new and improved minimally invasive surgeries are more precise,specific and effective in treating different types of EGC.

关键词： Minimally invasive surgery early gastric cancer Endoscopic mucosal resection Endoscopic full-thickness resection Laparoscopic and endoscopic cooperative surgery

Efficacy and safety of endoscopic submucosal dissection for early gastric cancer and precancerous lesions in elderly patients

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 511-517页

作者： Wen-Si Xu Hui-Yu Zhang Shuang Jin Qi Zhang Hong-Dan Liu Ming-Tao Wang Bo Zhang Department of Gastroenterology The Third Affiliated Hospital of Qiqihar Medical UniversityQiqihar 161099Heilongjiang ProvinceChina

BACKGROUND With advancements in the development of endoscopic technologies,the endo-scopic submucosal dissection(ESD)has been one of the gold-standard therapies for early gastric *** To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly *** Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were se-lected and classified into two groups according to the different surgical therapies they received between January 2021 and June *** them,39 patients treated with ESD were included in an experimental group,and 39 patients treated with endoscopic mucosal resection(EMR)were included in a control *** compared the basic intraoperative conditions,postoperative short-term recovery,long-term recovery effects and functional status of gastric mucosa between the two groups;the basic intraoperative conditions included lesion resection,intra-operative bleeding and operation time;the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complic-ations;and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoper-atively;and we compared the preoperative and predischarge serum pepsinogen I(PG I)and PG II levels and PG I/PG II ratio in the two groups before surgery and *** The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control *** intraoperative bleeding volume was higher in the experimental group than in the control *** operation time was longer in the experimental group than that in the control group,and the rate for base residual focus was lower in the experimental group than that of the control group,and the differences were all statistically signifi

关键词： Endoscopic submucosal dissection Endoscopic mucosal resection early gastric cancer Serum pepsinogen Elderly

Endoscopic submucosal dissection for early gastric cancer:A major challenge for the west

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 1965-1968页

作者： Francisco Schlottmann Department of Surgery University of Illinois at ChicagoChicagoIL 60612United States Department of Surgery Hospital Alemán of Buenos AiresBuenos Aires 1640-C1118AATArgentina

gastric cancer(GC)is the 5th most common cancer and the 3rd most common cause of cancer mortality *** main endoscopic resective techniques exist for early GC(EGC):Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD).ESD has been widely embraced in the last decade because it allows radical en bloc resections and is associated with better outcomes,as compared to ***,the lack of training opportunities and flat learning curve due to low volume of EGC cases represent major obstacles to obtain proficiency on ESD in the *** this procedure is highly efficient for the treatment of EGC,dedicated training programs with a stepwise approach and updated guidelines for ESD embracement are needed in Western countries.

关键词： gastric cancer early gastric cancer Endoscopy West Training

Chinese national clinical practice guidelines on the prevention,diagnosis,and treatment of early gastric cancer

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Chinese Medical Journal 2024年第8期137卷 887-908页

作者： Peng Li Ziyu Li Enqiang Linghu Jiafu Ji Society of Digestive Endoscopy of the Chinese Medical Association Colorectal Surgery Group of the Chinese Medical Association Chinese Association of Gastroenterologists&Hepatologists National Clinical Research Center for Digestive Diseases Chinese Medical Journal Clinical Practice Guideline Collaborative Department of Gastroenterology Beijing Friendship HospitalCapital Medical UniversityNational Clinical Research Center for Digestive DiseaseBeijing 100050China Department of Gastrointestinal Surgery Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education)Peking University Cancer Hospital and InstituteBeijing 100142China Department of Gastroenterology and Hepatology the First Medical CenterChinese People’s Liberation Army General HospitalBeijing 100853China 不详

Background:gastric cancer is one of the most common malignant tumors in the digestive system in *** comprehensive practice guidelines for early gastric cancer in China are currently ***,we created the Chinese national clinical practice guideline for the prevention,diagnosis,and treatment of early gastric ***:This clinical practice guideline(CPG)was developed in accordance with the World Health Organization’s recommended process and with the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)in assessing evidence *** used the Evidence to Decision framework to formulate clinical recommendations to minimize bias and increase transparency in the CPG development *** used the Reporting Items for practice Guidelines in HealThcare(RIGHT)statement and the Appraisal of Guidelines for Research and Evaluation II(AGREE II)as reporting and conduct guidelines to ensure completeness and transparency of the ***:This CPG contains 40 recommendations regarding the prevention,screening,diagnosis,treatment,and follow-up of early gastric cancer based on available clinical studies and *** provide recommendations for the timing of Helicobacter pylori eradication,screening populations for early gastric cancer,indications for endoscopic resection and surgical gastrectomy,follow-up interval after treatment,and other ***:This CPG can lead to optimum care for patients and populations by providing up-to-date medical *** intend this CPG for widespread adoption to increase the standard of prevention,screening,diagnosis,treatment,and follow-up of early gastric cancer;thereby,contributing to improving national health care and patient quality of life.

关键词： early gastric cancer Prevention Screening Diagnosis Treatment Follow-up

Long-term outcomes of endoscopic submucosal dissection for undifferentiated type early gastric cancer over 2 cm with R0 resection

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 326-334页

作者： Jun Yong Bae Chang Beom Ryu Moon Sung Lee Kulwinder S Dua Internal Medicine and Digestive Disease Center Seoul Medical CenterSeoul 02053South Korea Internal Medicine and Digestive Disease Center and Research Institute Soon Chun Hyang University of School of MedicineBucheon 14584South Korea Department of Medicine Medical College of WisconsinMilwaukeeWI 53226United States

BACKGROUND Endoscopic submucosal dissection(ESD)for over 2 cm in size undifferentiated type(UD type)early gastric cancer(EGC)confined to the mucosa is not only challenging,but also long-term outcomes are not well *** To evaluate the long-term outcomes of ESD done for UD type EGCs confined to the mucosa over 2 cm in size and compare the results with those where the lesions were less than 2 *** 143 patients with UD type EGC confirmed on histology after ESD at a tertiary hospital were *** with synchronous and metachronous lesions and a case with emergency surgery after ESD were excluded.A total of 137 cases were enrolled.79 cases who underwent R0 resection were divided into 2 cm or less(group A)and over 2 cm(group B)in *** Among 79 patients who underwent R0 resection,the number in group A and B were 51 and 28,*** mean follow-up period(SD)was 79.71±45.42 *** was a local recurrence in group A(1/51,2%)and group B(1/28,3.6%)*** patient in group A underwent surgery while the patient in group B underwent repeated ESD with no further recurrences in both *** was no regional lymph node metastasis,distant metastasis,and deaths in both *** R0 resection strategy for ESD on lesions over 2 cm,20.4%(28/137)of patients were able to avoid surgery compared with expanded *** If R0 resection is achieved by ESD,UD type EGCs over 2 cm also showed good and similar clinical outcomes as compared to lesions less than 2 cm when followed for over 5 *** R0 resection strategy,several patients can avoid surgery.

关键词： Undifferentiated type early gastric cancer Endoscopic submucosal dissection Long term outcomes Over 2 cm early gastric cancer

Challenges and advancing strategies of endoscopic submucosal dissection for early gastric cancer:The puzzle of eCura C1

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World Journal of Gastrointestinal Endoscopy 2024年第8期16卷 439-444页

作者： Giulio Calabrese Guido Manfredi Marcello F Maida Francesco V Mandarino Endrit Shahini Francesco Pugliese Paolo Cecinato Liboria Laterza Emanuele Sinagra Sandro Sferrazza Department of Gastroenterology and Endoscopy ARNAS Civico–Di Cristina–BenfratelliPalermo 90127SiciliaItaly Department of Gastroenterology and Digestive Endoscopy Ospedale MaggioreCrema 26013Italy Department of Medicine and Surgery University of Enna"Kore"Enna 94100SiciliaItaly Department of Gastroenterology and Digestive Endoscopy IRCCS Ospedale San RaffaeleMilan 20132LombardyItaly Department of Gastroenterology National Institute of Gastroenterology-IRCCS“Saverio de Bellis”Castellana GrotteBari 70013Italy Department of Digestive and Interventional Endoscopy Niguarda HospitalASST NiguardaMilan 20162LombardyItaly Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero-Universitaria di BolognaPoliclinico Sant’OrsolaBologna 40138Emilia-RomagnaItaly Department of Gastroenterology and Endoscopy Fondazione Instituto San Raffaele GiglioCefalù90015PalermoItaly

In this editorial,we explore the challenges of managing noncurative resections in early gastric cancer after endoscopic submucosal dissection(ESD),starting from the consideration recently made by Zhu et ***,we evaluate the management of eCura C1 lesions,where decisions regarding further interventions are pivotal yet *** among endoscopists,surgeons,and pathologists is underscored to refine risk assessment and personalize therapeutic *** advancements in ESD techniques and interdisciplinary collaboration offer opportunities for outcome optimization in managing eCura C1 ***,despite needing further clinical validation,molecular biomarkers have emerged as promising tools for enhancing *** manuscript highlights the ongoing research attempts to define treatment paradigms effectively and evaluates the potential of emerging options,ultimately aiming to improve patient care and outcomes in this complex clinical scenario.

关键词： early gastric cancer Endoscopic submucosal dissection eCura Non-curative resection Multidisciplinary approach

Editorial article to:Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer

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World Journal of Gastrointestinal Endoscopy 2024年第2期16卷 51-54页

作者： Enrico Fiori Antonietta Lamazza Daniele Crocetti Antonio V Sterpetti Department of Surgery Sapienza University of RomeRome 00161Italy Department of Surgery University of Rome La SapienzaRome 00161Italy

In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2023;15(11):*** cancer(GC)remains the fifth most common malignancy and the fourth leading cause of cancer-related death *** overall prevalence of GC has declined,although that of proximal GC has increased over ***,a significant proportion of GC cases and deaths can be avoided if preventive interventions are *** GC(EGC)is defined as GC confined to the mucosa or *** resection is considered the most appropriate treatment for precancerous gastrointestinal lesions improving patient quality of life,with reduced rates of complications,shorter hospitalization period,and lower costs when compared to surgical *** mucosal resection(EMR)and endoscopic sub-mucosal dissection(ESD)are representative endoscopic treatments for EGC and precancerous gastric *** EMR implies injection of a saline solution into the sub-mucosal space,followed by excision of the lesion using a *** resection rates vary depending on the size and severity of the *** using conventional EMR methods for lesions less than 1 cm in size,the complete resection rate is approximately 60%,whereas for lesions larger than 2 cm,the complete resection rate is low(20%-30%).ESD can be used to remove tumors exceeding 2 cm in diameter and lesions associated with ulcers or submucosal *** with EMR,ESD has higher en bloc resection rates(90.2%vs 51.7%),higher complete resection rates(82.1 vs 42.2%),and lower recurrence rates(0.65%vs 6.05%).Thus,innovative techniques have been introduced.

关键词： gastric cancer early gastric cancer Endoscopic resection Endoscopic mucosal resection Endoscopic sub-mucosal dissection

Clinical characteristics of patients with early gastric prematurity cancer and analysis of complications by endoscopic resection

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World Journal of Gastrointestinal Oncology 2024年第9期16卷 3898-3904页

作者： Hong Zhao Xiang-Yu Shi Li-Li Lv Yan-Zong Lai Xiao-Xiao Bao Jian-Wen Hu Department of Gastroenterology Dongyang People’s HospitalDongyang 322100Zhejiang ProvinceChina Department of Gastroenterology Yiwu Tianxiang Medical East HospitalYiwu 322100Zhejiang ProvinceChina Department of Pathology Dongyang People’s HospitalDongyang 322100Zhejiang ProvinceChina

BACKGROUND gastric cancer,a prevalent malignancy,poses a severe threat to the health of residents in *** intervention in early stages can extend patients’*** To analyze clinical characteristics of patients with early gastric cancer and efficacy and risk of complications associated with endoscopic *** This study included 175 patients with early gastric cancer treated at our hospital,with no restrictions on sex or *** data,pathological information,and endoscopic biopsy results were *** clinical characteristics of early gastric cancer were analyzed,and endoscopic resection was *** efficacy and incidence of complications were *** analysis was performed using SPSS 26.0 and GraphPad Prism 8.0 *** A total of 175 patients with early gastric cancer were included,with 75.43%(n=132)males and 24.57%(n=43)females.38.29%(n=67)and 35.43%(n=62)of patients had a history of smoking and alcohol consumption,*** included diabetes(8.57%,n=15),coronary heart disease(10.29%,n=18),and hypertension(43.43%,n=76),which was highly prevalent.A history of abdominal surgery and family history of digestive system cancer accounted for 21.14%and 17.14%,*** most common lesion location was the antral part of the stomach(52.00%,n=91),followed by the gastric angle,body,and *** pathological types were predominantly high-grade intraepithelial neoplasia(28.00%,n=49)and well-differentiated adenocarcinoma(26.86%,n=47),followed by moderately differentiated adenocarcinoma,high-moderately differentiated adenocarcinoma,and moderate-lowly differentiated adenocarcinoma.89.14%of the patients had intestinal metaplasia and 85.14%had *** endoscopic resection,re-examination revealed that 13 patients had cancer cells at the tissue margin,with a positive margin rate of 7.43%.Postoperative complications included no cases of gastrointestinal obstruction,but incisional infec

关键词： early gastric cancer Clinical characteristics Endoscopic resection Complications

early gastric cancer:A challenge in Western countries

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World Journal of Gastroenterology 2022年第7期28卷 693-703页

作者： Maria Michela Chiarello Valeria Fico Gilda Pepe Giuseppe Tropeano Neill James Adams Gaia Altieri Giuseppe Brisinda Department of Surgery Azienda Sanitaria Provinciale di CrotoneOspedale San Giovanni di DioCrotone 88900Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Health Sciences Clinical Microbiology UnitMagna Grecia UniversityCatanzaro 88100Italy Department of Medical and Surgical Sciences Catholic School of MedicineRome 00168Italy Department of Surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

early gastric cancer(EGC)is an invasive carcinoma involving only the stomach mucosa or submucosa,independently of lymph node *** 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 *** 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 ***,EGCs are curable if the lesion is completely removed by endoscopic resection or *** types of EGC can be resected endoscopically;for others the most appropriate treatment is surgical resection and D2 lymphadenectomy,especially in Western *** 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.

关键词： early gastric cancer Diagnosis Treatment Endoscopic resection Surgery Lymph nodes metastases