Lymph node metastases in early gastric cancer: Japanese Gastric Cancer Treatment Guidelines can be used for endoscopic resection in the West

Edward Young; Louisa Edwards; Aashish Maurya; Andrew Ruszkiewicz; Hamish Philpott; Rajvinder Singh

doi:10.1055/a-2749-4324

Endoscopy International Open, Table of Contents

CC BY 4.0 · Endosc Int Open 2025; 13: a27494324
DOI: 10.1055/a-2749-4324

Original article

Lymph node metastases in early gastric cancer: Japanese Gastric Cancer Treatment Guidelines can be used for endoscopic resection in the West

Authors

Edward Young

¹School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide Press, Adelaide, Australia (Ringgold ID: RIN1066)

²Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia (Ringgold ID: RIN3187)
Louisa Edwards

³Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia (Ringgold ID: RIN1062)

¹School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide Press, Adelaide, Australia (Ringgold ID: RIN1066)
Aashish Maurya

²Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia (Ringgold ID: RIN3187)

¹School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide Press, Adelaide, Australia (Ringgold ID: RIN1066)
Andrew Ruszkiewicz

⁴Tissue Pathology, Lyell McEwin Hospital, Elizabeth Vale, Australia (Ringgold ID: RIN3187)
Hamish Philpott

²Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia (Ringgold ID: RIN3187)

¹School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide Press, Adelaide, Australia (Ringgold ID: RIN1066)
Rajvinder Singh

⁵Gastroenterology and Hepatology, Lyell McEwin Hospital, Elizabeth Vale, Australia (Ringgold ID: RIN3187)

¹School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide Press, Adelaide, Australia (Ringgold ID: RIN1066)

Abstract

Background and study aims

The eCura system has been shown to accurately delineate early gastric cancers with negligible risk of lymph node metastases, which, therefore, would be considered endoscopically cured. However, this classification was based predominantly on data from high-incidence Eastern countries. We sought to assess whether these criteria can be safely applied in a Western population.

Patients and methods

Data were retrospectively recorded for patients who underwent gastrectomy in four Australian tertiary centee over two decades. Demographic data, lesion characteristics (size, differentiation, invasion depth, lymphovascular invasion, and ulceration) as well as number of lymph node metastases was recorded. Patients given neoadjuvant chemotherapy were excluded.

Results

A total of 1,465 gastrectomy specimens were reviewed, including in 558 patients who underwent resection of gastric adenocarcinoma without neoadjuvant chemotherapy (mean age 67.9, 64.2% male). Of these, 101 (18.1%, confidence interval [CI] 15.4%-21.9%) had T1 disease (T1a = 30, T1b = 71). Of the lesions, 11.5% (n = 64, CI 9.1%-14.4%) met the 2021 Japanese "absolute criteria" for endoscopic resection, with 7.8% of these (n = 5, CI 3.4%-17%) having positive lymph nodes at gastrectomy. Of them, 9.9% (n = 55, CI 7.6%-12.6%) would have been considered eCura A or B, with none of these having positive lymph nodes at gastrectomy.

Conclusions

The eCura system for defining endoscopic curability could have been safely applied in this Western population. Even in Western countries, patients with early gastric cancer that meets Japanese guidelines for endoscopic resection should, where possible, undergo en bloc endoscopic submucosal dissection. Lesions classified histologically as eCuraA or B should be considered endoscopically cured.

Keywords

Endoscopy Upper GI Tract - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Endoscopic resection (ESD, EMRc, ...) - GI Pathology

Bibliographical Record
Edward Young, Louisa Edwards, Aashish Maurya, Andrew Ruszkiewicz, Hamish Philpott, Rajvinder Singh. Lymph node metastases in early gastric cancer: Japanese Gastric Cancer Treatment Guidelines can be used for endoscopic resection in the West. Endosc Int Open 2025; 13: a27494324.
DOI: 10.1055/a-2749-4324

Full Text

References

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