Early gastric cancer: clinico-morphological study of the safeness of expanded criteria for endoscopic resection
Endoscopic resection (ER) is a common option of treatment for patients with early gastric cancer, in case if tumor's parameters meet standard or expanded indications for ER, however the expanded criteria’s oncological safeness is yet being studied. Objective: to evaluate the oncological safeness of expanded indications for endoscopic resection in patients with early gastric cancer by analyzing the material of N.N. Blokhin NMRCO, considering the frequency of metastasis and survival rate of patients with EGC according to indications for ER. Methods: We studied surgery material of 404 patients with early gastric cancer, who have undergone radical surgeries in Federal State Budgetary Institution «N.N. Blokhin National Medical Research Center of Oncology» оf the Ministry of Health of the Russian Federation during the period since November 1990 till December 2006. We have measured the level of regional metastasing and tracked 10- and 15-year survival for all of these patients. Absolute and relative indications for ER of RGC have been applied to the general group of patients, there has been measured the risk level of the regional metastasing and we analyzed the reduction of risk level of metastasing with the usage of absolute indications for ER of EGC in all groups of patients. Results: metastases in lymphatic nodes were detected in 54 cases (13, 4%) of EGC: 50 patients met absolute indications, in this group of patient metastatic process has not been revealed. In the group with 125 patients with EGC who met expanded indications, there have been detected metastases in regional lymph nodes in 3 patients (2.4%). The ulceration has been the most important criteria in risk level of metastasing of EGC. Conclusions: In general, the expanding of indications for ER of EGC is reasonable with minimal excess of risk in comparison with absolute indications. However, the expansion of indications must be sorted with surgery risks for these patients.