Many patients are apprehensive about open surgery. So, is there a way to cut out stomach cancer without surgery? Endoscopic resection is the answer to this need. In this article, we will explain which gastric cancers can be removed without surgery.
What can be resected endoscopically?
Endoscopic resection is usually used for early gastric cancer, when the lesion is confined to the innermost mucosal or submucosal layer of the stomach wall. However, not all early gastric cancers are suitable for endoscopic resection. The size of the lesion and the type of pathology also determine whether endoscopic resection is possible. Usually, gastric cancer less than 2 cm in diameter can be completely resected endoscopically, while gastric cancer of 2-3 cm in diameter can also be considered for endoscopic resection. Considering the type of gastric cancer, the doctor will decide whether endoscopic mucosal resection can be performed by taking into account the pathological type and specific situation, and differentiated gastric cancer is usually the first choice for endoscopic treatment. For early gastric cancer, patients need close follow-up after endoscopic resection because it is difficult to determine lymph node metastasis preoperatively.
What cannot be resected endoscopically?
Surgeons will consider open or laparoscopic surgical resection for the following cancers that cannot be removed endoscopically:
- Gastric cancer lesions less than 3 cm in diameter with ulcers on the surface are sometimes considered open or laparoscopic depending on the type of pathology (usually undifferentiated);
- Endoscopic determination of residual lesion;
- Gastric cancer lesions larger than 3 cm in diameter;
- The lesion invaded the submucosa and the whole lesion could not be removed at once only in pieces or with positive cut margins.
What are the advantages and disadvantages of endoscopic resection?
Advantages
Advantages
- Less invasive, less intraoperative bleeding, and facilitates early recovery;
- Can treat multiple sites of gastric cancer at one time;
- Endoscopic mucosal dissection (ESD) has the feature of complete resection of the lesion, which is less likely to spread and implant tumor cells in other areas during the operation, and more complete histopathological specimens can be obtained;
- For early gastric cancer with large area, irregular morphology, and some depth, or tumor combined with cauliflower ulcer, endoscopic mucosal resection (EMR) can achieve more than 96% resection rate and low postoperative recurrence rate.
Inadequate
- The need to clarify whether it is early gastric cancer, i.e., the determination of the depth of tumor infiltration needs to be accurate, otherwise it may cause the problem of residual cancer cells;
- If the gastric wall is thin and the lesion is deep, perforation of the gastric wall may occur, requiring emergency open surgery for treatment;
- After resection of gastric cancer, there is a possibility of blood leakage from the wound and it is not easily detected after surgery;
- Operation through the patient’s esophagus into the gastric cavity, which may lead to nausea and other discomfort;
- When treatment is performed under general anesthesia, recovery of postoperative pulmonary function may also be compromised, especially in some patients with underlying cardiopulmonary disease.
In conclusion, although there are limitations to endoscopic resection of early gastric cancer, endoscopic “no-incision” resection of gastric cancer can provide an economical and less invasive approach for eligible patients. (Contributed by Chao Han, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)