Minimally invasive and local treatment for mucosal early gastric cancer

Background: Early gastric cancer (EGC) can present an indication for local resection procedures under pertain circumstances. Especially endoscopic mucosal resections (EMRs) and laparoscopic resections or those combined with endoscopy have been made possible in recent years. Methods: From 1996 to 2004, of a total of 425 patients with gastric cancer, 58 patients with EGC (13.6%) were prospectively analyzed and observed. Of these, 35 patients had preoperatively diagnosed submucosal infiltration and subsequently underwent gastrectomy and standard lymphnodectomy. Of the 23 patients with intramucosal EGC, 22 underwent local resection. One patient displayed lymph node and liver metastasis at the time of diagnosis and received chemotherapy following staging laparoscopy. Results: Among the 23 patients with intramucosal EGC, 13 were female and 10 male. The average age of the patients was 77.4 years (range: 69-86). The rate of lymph node metastasis was 12.5% (n = 35) for submucosal EGC and 4.3% (n = 23) for intramucosal EGC. Twenty-two patients with intramucosal EGC underwent local resection (four EMR, six laparoscopic intragastric resection, 12 laparoscopic wedge resection). The average tumor size was 1.2 cm (range 0.3-2.3). The definitive histological findings yielded in all patients tumor-free resection margins without venous or lymphangic in. filtration. In 10 of 18 patients undergoing laparoscopic resection a simultaneous sentinel lymph node sampling (4 +/- 3 LN) was performed. There were no metastases detected. Method-specific complications did not occur. The morbidity of this patient group was 13.6% (three of 22). Mortality was zero. The average postoperative hospital stay was 6.5 days (range 2-12). In the median follow-up of 30.3 months (range 1-86) no recurrences have yet been diagnosed. Four patients died within the observation period of non-cancer-related causes. Conclusions: Minimally invasive local resection of intramucosal EGC represents a favorable option when strict determination of indication has taken place.