Adachi Yosuke, Shiraishi Norio, Kitano Seigo
First Department of Surgery, Oita Medical University, Oita, Japan.
Dig Surg. 2002;19(5):333-9. doi: 10.1159/000065829.
Recently, detections of early gastric cancer (EGC) have been increasing, and the treatment strategies for gastric cancer have been changing. To demonstrate recent clinical experience of EGC in Japan and to assess modern strategies for the treatment of EGC, we investigated the English-language literature of the past 10 years through computer searches.
This article intends to provide gastric surgeons with recent Japanese experience of the treatment for EGC. In a search for modern treatments of EGC, we selected 100 papers published in well-known medical journals, and focused on the following items of EGC: (1) prognostic factors, (2) endoscopic treatment, (3) surgical procedures, and (4) Japanese guidelines.
The most important factor influencing the survival of patients with EGC is the status of lymph node metastasis. The incidence of lymph node metastasis is 1-3% for mucosal cancers and 11-20% for submucosal cancers. Endoscopic mucosal resection (EMR) is a technique for the treatment of EGC, and the recent indication includes the tumors confined to the mucosa up to 3 cm in size or those invading the superficial submucosa. Surgical procedures include conventional Billroth I gastrectomy, limited resections, and laparoscopic surgery. Laparoscopic wedge resection using the lesion-lifting method and laparoscopy-assisted distal gastrectomy provide less pain, faster recovery and shorter hospital stay. Guidelines for the treatment of gastric cancer proposed by the Japanese Gastric Cancer Association show that patients with mucosal cancer can be managed by EMR or distal gastrectomy, whereas patients with submucosal cancer are candidates for distal gastrectomy with lymph node dissection.
Although the prognosis of patients with EGC depends on the presence or absence of lymph node metastasis, most are successfully treated by modern endoscopic or surgical techniques. Laparoscopic surgery and limited resections will contribute to the better quality of life of patients with EGC.
近年来，早期胃癌（EGC）的检出率不断上升，胃癌的治疗策略也在发生变化。为了展示日本近期EGC的临床经验并评估EGC的现代治疗策略，我们通过计算机检索调查了过去10年的英文文献。
本文旨在为胃肠外科医生提供日本近期EGC的治疗经验。在寻找EGC的现代治疗方法时，我们选择了在知名医学杂志上发表的100篇论文，并重点关注EGC的以下方面：（1）预后因素，（2）内镜治疗，（3）手术方法，以及（4）日本指南。
影响EGC患者生存的最重要因素是淋巴结转移情况。黏膜癌的淋巴结转移发生率为1%-3%，黏膜下癌为11%-20%。内镜黏膜切除术（EMR）是治疗EGC的一种技术，近期的适应证包括局限于黏膜层、大小达3 cm或侵犯浅表黏膜下层的肿瘤。手术方法包括传统的毕Ⅰ式胃切除术、局限性切除术和腹腔镜手术。采用病变提起法的腹腔镜楔形切除术和腹腔镜辅助远端胃切除术疼痛较轻、恢复较快且住院时间较短。日本胃癌协会提出的胃癌治疗指南表明，黏膜癌患者可采用EMR或远端胃切除术治疗，而黏膜下癌患者则适合行远端胃切除术并进行淋巴结清扫。
虽然EGC患者的预后取决于有无淋巴结转移，但大多数患者可通过现代内镜或手术技术成功治疗。腹腔镜手术和局限性切除术将有助于提高EGC患者的生活质量。
