Published online Apr 14, 2019. doi: 10.3748/wjg.v25.i14.1640
Peer-review started: February 17, 2019
First decision: February 26, 2019
Revised: March 9, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: April 14, 2019
The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinic-pathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize post-gastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.
Core tip: The surgical treatment for early gastric cancer seems to be appropriately radical, because almost all patients can be cured by gastrectomy with lymph-node dissection up to D1+. However, after D1+ gastrectomy, multiple functional symptoms are caused by the loss of the stomach. Physicians must strive to reduce post-gastrectomy symptoms and optimize quality of life. About two-thirds of early gastric cancers are node-negative and can be resected by endoscopic submucosal dissection. The extent of lymph-node dissection can be individualized, and significant gastric preservation can be achieved, with sentinel-node biopsy. The operative method itself is still in transition.