Chiarello MM, Fico V, Pepe G, Tropeano G, Adams NJ, Altieri G, Brisinda G. Early gastric cancer: A challenge in Western countries. World J Gastroenterol 2022; 28(7): 693-703 [PMID: 35317273 DOI: 10.3748/wjg.v28.i7.693]
Corresponding Author of This Article
Giuseppe Brisinda, MD, Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 21, 2022; 28(7): 693-703 Published online Feb 21, 2022. doi: 10.3748/wjg.v28.i7.693
Early gastric cancer: A challenge in Western countries
Maria Michela Chiarello, Valeria Fico, Gilda Pepe, Giuseppe Tropeano, Neill James Adams, Gaia Altieri, Giuseppe Brisinda
Maria Michela Chiarello, Department of Surgery, Azienda Sanitaria Provinciale di Crotone, Ospedale San Giovanni di Dio, Crotone 88900, Italy
Valeria Fico, Gilda Pepe, Giuseppe Tropeano, Gaia Altieri, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Neill James Adams, Health Sciences, Clinical Microbiology Unit, Magna Grecia University, Catanzaro 88100, Italy
Giuseppe Brisinda, Department of Medical and Surgical Sciences, Catholic School of Medicine, Rome 00168, Italy
Giuseppe Brisinda, Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Author contributions: Chiarello MM and Brisinda G conceived the original idea; Fico V, Pepe G, Altieri G and Tropeano G performed a comprehensive review of all available literature and synthesized the data; Chiarello MM, Fico V, Adams NJ and Brisinda G wrote the manuscript; Chiarello MM, Fico V, Pepe G, Altieri G, Tropeano G and Brisinda G contributed to the study design, manuscript structure and performed a final critical appraisal of the manuscript; Chiarello MM, Fico V, Pepe G, Tropeano G, Adams NJ, Altieri G and Brisinda G read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Brisinda, MD, Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Received: October 26, 2021 Peer-review started: October 26, 2021 First decision: December 27, 2021 Revised: January 4, 2022 Accepted: January 22, 2022 Article in press: January 22, 2022 Published online: February 21, 2022
Abstract
Early gastric cancer (EGC) is an invasive carcinoma involving only the stomach mucosa or submucosa, independently of lymph node status. EGC 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 countries. The 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 EGC. Generally, EGCs are curable if the lesion is completely removed by endoscopic resection or surgery. Some types of EGC can be resected endoscopically; for others the most appropriate treatment is surgical resection and D2 lymphadenectomy, especially in Western countries. The 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.
Core Tip: Early gastric cancer (EGC) is an invasive stomach cancer confined to the mucosal or submucosal lining and represents approximately 20% of gastric cancers in Western countries. A correct classification allows the most appropriate treatment. Some types of EGC are adequately treated by endoscopic mucosal resection, whilst others need gastrectomy. In Western countries, due to a higher incidence of the diffuse histotype and the less widespread advanced endoscopic procedures, surgical resection and D2 lymphadenectomy are regarded as the “gold standard” treatment.
