History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

doi:10.3877/cma.j.issn.2095-7157.2020.01.001

Abstract

Abstract:

Japanese guidelines for gastric cancer treatment were first published in 2001 for the purpose of showing the appropriate indication for each treatment method, thereby reducing differences in the therapeutic approach among institutions, and soon. With the accumulation of evidence and the development and prevalence of endoscopic submucosal dissection (ESD), the criteria for the indication and curability of endoscopic resection (ER) for early gastric cancer (EGC) have expanded. However, several problems still remain. Although a risk-scoring system (eCura system) for predicting lymph node metastasis (LNM) may help treatment decision in patients who do not meet the curative criteria for ER of EGC, which is referred to as eCura C-2 in the latest guidelines, additional gastrectomy with lym-phadenectomy may be excessive for many patients, even those at high risk for LNM. Less-invasive function-preserving surgery, such as non-exposed endoscopic wall-inversion surgery with laparoscopic sentinel node sampling, may over-come this problem. In addition, further less-invasive treatment, such as ER with chemotherapy, should be established for patients who prefer not to undergo additional gastrectomy.

Key words: Curability, Early gastric cancer, Endoscopic resection, Guidelines, Indication

Hatta Waku, Gotoda Takuji, Koike Tomoyuki, Masamune Atsushi. History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2020, 07(01): 1-10.

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References 87

[1]	Global Burden of Disease Cancer Collaboration. The global burden of cancer 2013[J]. JAMA Oncol, 2015，1(4): 505-527.
[2]	Karimi P, Islami F, Anandasabapathy S, et al.Gastric cancer：descriptive epidemiology, riskfactors, screening, and prevention[J]. Cancer Epidemiol Biomark Prev，2014, 23(5): 700-713.
[3]	de Martel C, Forman D, Plummer M. Gastric cancer: epidemiology and risk factors. Gastroenterol[J]. Clin North Am，2013, 42(2):219-240.
[4]	Suh M, Choi KS, Lee YY, et al. Trends in cancer screening rates among Korean men and women: results from the Korean National Cancer Screening Survey, 2004-2012[J]．Cancer Res Treat，2013, 45(2): 86-94.
[5]	Kim YG, Kong SH, Oh SY，et al. Effects of screening on gastric cancer management: comparative analysis of the results in 2006and in 2011[J]．J Gastric Cancer，2014，14(2): 129-134.
[6]	Japanese Gastric Cancer Association Registration C, Maruyama K, Kaminishi M，et al. Gastric cancer treated in 1991 in Japan：data analysis of nationwide registry[J]．Gastric Cancer，2006，9(2):51-66.
[7]	Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition[J]．Gastric Cancer，2011，14(2): 101-112.
[8]	Gotoda T, Jung HY. Endoscopic resection (endoscopic mucosal resection/endoscopic submucosal dissection) for early gastric cancer[J]．Dig Endosc，2013, 25(Suppl 1): 55-63.
[9]	Japanese Gastric Cancer Association. Gastric Cancer Treatment Guideline. (in Japanese). Tokyo: Kanehara，2001.
[10]	Japanese Gastric Cancer Association. Gastric Cancer Treatment Guideline, 2nd edn. (in Japanese). Tokyo: Kanehara，2004.
[11]	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010(ver. 3) [J]．Gastric Cancer，2011，14(2):113-123.
[12]	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4) [J]．Gastric Cancer，2017, 20(1):1-19.
[13]	Japanese Gastric Cancer Association. Gastric Cancer Treatment Guideline, 5th edn. (in Japanese). Tokyo: Kanehara，2018.
[14]	Ono H, Yao K, Fujishiro M，et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection forearly gastric cancer[J]．Dig Endosc，2016，28(1): 3-15.
[15]	Shiu MH, Moore E, Sanders M，et al. Influence of the extent of resection on survival after curative treatment of gastric carcinoma. A retrospective multivariate analysis[J]．Arch Surg，1987，122(11): 1347-1351.
[16]	Itoh H, Oohata Y, Nakamura K, et al. Complete ten-year postgastrectomy follow-up of early gastric cancer[J]．Am J Surg，1989，158(1): 14-16.
[17]	Sano T, Sasako M, Kinoshita T, et al. Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature[J]．Cancer，1993，72(11): 3174-3178.
[18]	Saka M, Katai H, Fukagawa T, et al. Recurrence in early gastric cancer with lymph node metastasis[J]．Gastric Cancer，2008，11(4): 214-218.
[19]	Sasako M. Risk factors for surgical treatment in the Dutch Gastric Cancer Trial[J]．Br J Surg，1997, 84(11): 1567-1571.
[20]	Hirao M, Masuda K, Asanuma T, et al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine[J]．Gastrointest Endosc，1988，34(3):264-269.
[21]	Tanabe S, Koizumi W, Mitomi H，et al. Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer[J]．Gastrointest Endosc，2002，56(5): 708-713.
[22]	Eguchi T, Gotoda T, Oda I, et al. Is endoscopic one-piece mucosal resection essential for early gastric cancer [J]．Dig Endosc，2003，15(2): 113-116.
[23]	Soetikno R, Kaltenbach T, Yeh R, et al. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract[J]．J. Clin Oncol，2005, 23(20): 4490-4498.
[24]	Gotoda T. Endoscopic resection of early gastric cancer[J]．Gastric Cancer 2007; 10(1): 1-11.
[25]	Sasako M, Kinoshita T, Maruyama K. Prognosis of early gastric cancer (in Japanese with English abstract) [J]．Stomach Intestine，1993，28: 139-146.
[26]	Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer[J]. J Gastroenterol，2006，41(10): 929-942.
[27]	Tada M, Murakami A, Karita M，et al. Endoscopic resection of early gastric cancer[J]．Endoscopy，1993，25(7): 445-450.
[28]	Gotoda T, Kondo H, Ono H，et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases[J]. Gastrointest Endosc，1999，50(4): 560-563.
[29]	Park YM, Cho E, Kang HY, et al. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and meta analysis[J]．Surg Endosc，2011，25(8): 2666-2677.
[30]	Lian J, Chen S, Zhang Y, et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer[J]．Gastrointest Endosc，2012，76(4): 763-770.
[31]	Facciorusso A, Antonino M, Di Maso M, et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis[J]．World J Gastrointest Endosc，2014，6(11): 555-563.
[32]	Fujishiro M, Yoshida S, Matsuda R，et al. Updated evidence on endoscopic resection of early gastric cancer from Japan[J]. Gastric Cancer，2017, 20(Suppl 1): 39-44.
[33]	Yamao T, Shirao K, Ono H et al. Risk factors for lymph node metastasis from intramucosal gastric carcinoma[J]. Cancer，1996，77(4): 602-606.
[34]	Tsujitani S, Oka S, Saito H，et al. Less invasive surgery forearly gastric cancer based on the low probability of lymph node metastasis[J]. Surgery，1999，125(2): 148-154.
[35]	Gotoda T, Yanagisawa A, Sasako M，et al. Incidence of lymphnode metastasis from early gastric cancer: estimation with alarge number of cases at two large centers[J]．Gastric Cancer，2000，3(4): 219-225.
[36]	Hirasawa T, Gotoda T, Miyata S，et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer[J]．Gastric Cancer，2009，12(3): 148-152.
[37]	Hasuike N, Ono H, Boku N et al. A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a)：the Japan Clinical Oncology Group study (JCOG0607) [J]．Gastric Cancer，2018，21(1): 114-123.
[38]	Hatta W, Gotoda T, Oyama T，et al. A scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer: "eCura system" [J]．Am J Gastroenterol，2017，112(6): 874-881.
[39]	Tanabe S, Ishido K, Matsumoto T，et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: amulti center collaborative study[J]．Gastric Cancer，2017，20(Suppl 1): 45-52.
[40]	Fujii H, Ishii E, Tochitani S，et al. Lymph node metastasis after endoscopic submucosal dissection of a differentiated gastric cancer confined to the mucosa with an ulcer smaller than30 mm[J]．Dig Endosc，2015，27(1): 159-161.
[41]	Oda I, Oyama T, Abe S，et al. Preliminary results of multi center questionnaire study on long-term outcomes of curative endoscopic submucosal dissection for early gastric cancer[J]．Dig Endosc，2014，26(2): 214-219.
[42]	Jung DH, Bae YS, Yoon SO，et al. Poorly differentiated carcinoma component in submucosal layer should be considered as an additional criterion for curative endoscopic resection of early gastric cancer[J]．Ann Surg Oncol，2015，22(Suppl 3):S772-777.
[43]	Miyahara K, Hatta W, Nakagawa M，et al. The role of an undifferentiated component in submucosal invasion and submucosal invasion depth after endoscopic submucosal dissection for early gastric cancer[J]．Digestion，2018，98(3): 161-168.
[44]	Horiuchi Y, Fujisaki J, Yamamoto N，et al. Undifferentiated type component mixed with differentiated-type early gastric cancer is a significant risk factor for endoscopic non-curative resection[J]．Dig Endosc，2018，30(5): 624-632.
[45]	Sun K, Chen S, Ye J，et al. Endoscopic resection versus surgery for early gastric cancer: a systematic review and meta-analysis[J]．Dig Endosc，2016，28(5): 513-525.
[46]	Kumei S, Nakayama T, Watanabe T，et al. Impact of examining additional deeper sections on the pathological diagnosis of endoscopically resected early gastric cancer[J]．Dig Endosc，2019，31(4): 405-412.
[47]	Suzuki H, Oda I, Abe S，et al. Clinical outcomes of early gastric cancer patients after noncurative endoscopic submucosal dissection in a large consecutive patient series[J]．Gastric Cancer，2017，20(4): 679-689.
[48]	Suzuki H, Takizawa K, Hirasawa T，et al. Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: 'Real-world evidence' in Japan[J]．Dig Endosc, 2019，31(1): 30-39.
[49]	Kawata N, Kakushima N, Takizawa K，et al. Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection[J]．Surg Endosc，2017，31(4): 1607-1616.
[50]	Kikuchi S, Kuroda S, Nishizaki M，et al. Management of early gastric cancer that meet the indication for radical lymph node dissection following endoscopic resection: a retrospective ecohort analysis[J]．BMC Surg，2017，17(1): 72.
[51]	Kim ER, Lee H, Min BH，et al. Effect of rescue surgery after non-curative endoscopic resection of early gastric cancer[J]．Br J Surg，2015，102(11): 1394-1401.
[52]	Yano T, Ishido K, Tanabe S，et al. Long-term outcomes of patients with early gastric cancer found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after endoscopic submucosal dissection[J]．Surg Endosc，2018，32(3): 1314-1323.
[53]	Ito H, Inoue H, Ikeda H，et al. Surgical outcomes and clinicopathological characteristics of patients who under wentpotentially noncurative endoscopic resection for gastric cancer: a report of a single-center experience[J]. Gastroenterol Res Pract，2013，2013: 427405.
[54]	Hoteya S, Iizuka T, Kikuchi D，et al. Clinic opathological outcomes of patients with early gastric cancer after noncurative endoscopic submucosal dissection[J]．Digestion，2016，93(1): 53-58.
[55]	Sunagawa H, Kinoshita T, Kaito A，et al. Additional surgery for non-curative resection after endoscopic submucosal dissectionfor gastric cancer: a retrospective analysis of 200 cases[J]．Surg Today，2017，47(2): 202-209.
[56]	Toyokawa T, Ohira M, Tanaka H，et al. Optimal management for patients not meeting the inclusion criteria after endoscopic submucosal dissection for gastric cancer[J]．Surg Endosc，2016，30(6): 2404-2414.
[57]	Yamanouchi K, Ogata S, Sakata Y，et al. Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer[J]. Endosc Int Open，2016，4(1): E24-29.
[58]	Jung DH, Huh CW, Kim JH，et al. Risk-stratification model based on lymph node metastasis after noncurative endoscopic resection for early gastric cancer[J]. Ann Surg Oncol，2017, 24(6):1643-1649.
[59]	Probst A, Schneider A, Schaller T，et al. Endoscopic submucosal dissection for early gastric cancer: are expanded resection criteria safe for Western patients? [J]．Endoscopy，2017，49(9): 855-865.
[60]	Kim HS, Ahn JY, Kim SO, et al. Can further gastrectomybe avoided in patients with incomplete endoscopic resection? [J]．Surg Endosc，2017，31(11): 4735-4748.
[61]	Esaki M, Hatta W, Shimosegawa T，et al. Age affects clinical management after noncurative endoscopic submucosal dissection for early gastric cancer[J]．Dig Dis, 2019，37(6):423-433.
[62]	Hatta W, Gotoda T, Oyama T，et al. Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? [J]．A comparative study Gastric Cancer，2018，21(3): 481-489.
[63]	Takizawa K, Hatta W, Gotoda T，et al. Recurrence patterns and outcomes of salvage surgery in cases of non-curative endoscopic submucosal dissection without additional radical surgery for early gastric cancer[J]．Digestion，2019，99(1): 52-58.
[64]	Hatta W, Gotoda T, Oyama T，et al. Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? Amulti-center retrospective study in Japan[J]．J Gastroenterol，2017，52(2): 175-184.
[65]	Suzuki S, Gotoda T, Hatta W，et al. Survival benefit of additional surgery after non-curative endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis[J]. Ann Surg Oncol，2017，24(11): 3353-3360.
[66]	Niwa H, Ozawa R, Kurahashi Y，et al. The eCura system as anovel indicator for the necessity of salvage surgery after noncurative ESD for gastric cancer: a case-control study[J]．PLoS ONE，2018，13(10):e0204039.
[67]	Takizawa K, Ono H, Hasuike N，et al. Su1366 A non-randomized single-arm confirmatory trial of endoscopic submucosal dissection to expand its indication for early gastric cancer of undifferentiated type: Japan Clinical Oncology Group Study(JCOG1009/1010) [J]．Gastrointest Endosc，2019，89(6): AB347-348.
[68]	Hatta W, Gotoda T, Oyama T，et al. Is additional surgery always sufficient for preventing recurrence after endoscopic submucosal dissection with curability C-2 for early gastric cancer？[J]．Ann Surg Oncol，2019, 26(11): 3636-3643.
[69]	Pimentel-NunesP, Dinis-RibeiroM, PonchonT，et al.Endoscopic submucosal dissection: European Society of Gastro intestinal Endoscopy (ESGE) Guideline[J]．Endoscopy，2015，47(9): 829-854.
[70]	Guideline Committee of the Korean Gastric Cancer AssociationDWG, Review P. Korean Practice Guideline for Gastric Cancer2018: an evidence-based, multi-disciplinary approach[J]. J Gastric Cancer，2019，19(1): 1-48.
[71]	NCCN Clinical Practice Guidelines in Oncology (NCCN guidelines). Gastric Cancer. Version 2.2019. Accessed 24，June，2019. URL
[72]	Hanada Y, Choi AY, Hwang JH，et al. Low frequency of lymphnode metastases in patients in the United States with early-stagegastric cancers that fulfill Japanese endoscopic resectioncriteria.[J]．Clin Gastroenterol Hepatol，2019，17(9): 1763-1769.
[73]	Ma MX, Bourke MJ. Endoscopic submucosal dissection in theWest: current status and future directions[J]．Dig Endosc，2018，30(3): 310-320.
[74]	Aoyama J, Kawakubo H, Goto O，et al. Potential for localresection with sentinel node basin dissection for early gastric cancer based on the distribution of primary sites[J]. Gastric Cancer，2019，22(2): 386-391.
[75]	Teoh AY, Chiu PW. Collaboration between laparoscopicsurgery and endoscopic resection: an evidence-based review[J]．Dig Endosc，2014，26(Suppl 1): 12-19.
[76]	Takeuchi H, Kitagawa Y. New sentinel node mappingtechnologies for early gastric cancer[J]．Ann Surg Oncol，2013，20(2): 522-532.
[77]	Takeuchi H, Kitagawa Y. Sentinel node navigation surgery inpatients with early gastric cancer[J]．Dig Surg，2013，30(2): 104-111.
[78]	Kitagawa Y, Takeuchi H, Takagi Y，et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan[J]．J Clin Oncol，2013，31(29): 3704-3710.
[79]	Takeuchi H, Goto O, Yahagi N, et al. Functionpreserving gastrectomy based on the sentinel node concept inearly gastric cancer[J]．Gastric Cancer，2017，20(Suppl 1): 53-59.
[80]	Hiki N, Nunobe S. Laparoscopic endoscopic cooper ative surgery (LECS) for the gastrointestinal tract: updated indications[J]．Ann Gastroenterol Surg，2019，3(3): 239-246.
[81]	Nunobe S, Hiki N, Gotoda T，et al. Successful application of laparoscopic and endoscopic cooperative surgery (LECS) for alateral-spreading mucosal gastric cancer[J]．Gastric Cancer，2012，15(3): 338-342.
[82]	Goto O, Mitsui T, Fujishiro M，et al. New method ofendoscopic full-thickness resection: a pilot study of non-exposed endoscopic wall-inversion surgery in an ex vivo porcine model[J]．Gastric Cancer，2011，14(2): 183-187.
[83]	Goto O, Takeuchi H, Kawakubo H，et al. First case of nonexposed endoscopic wall-inversion surgery with sentinel node basin dissection for early gastric cancer[J]．Gastric Cancer，2015，18(2): 434-439.
[84]	Inoue H, Ikeda H, Hosoya T，et al. Endoscopic mucosal resection, endoscopic submucosal dissection, and be yond：full-layer resection for gastric cancer with nonexposure technique (CLEAN-NET) [J]. Surg Oncol Clin NAm，2012，21(1): 129-140.
[85]	Kikuchi S, Nishizaki M, Kuroda S，et al. Nonexposurelaparoscopic and endoscopic cooperative surgery (closedlaparoscopic and endoscopic cooperative surgery) for gastric submucosal tumor[J]. Gastric Cancer，2017，20(3): 553-557.
[86]	Minashi K, Nihei K, Mizusawa J et al. Efficacy of endoscopic resection and selective chemoradiotherapy for Stage I esophageal squamous cell carcinoma[J]．Gastroenterology, 2019，157(2):382-390,e3.
[87]	Sakuramoto S, Sasako M, Yamaguchi T，et al. Adjuvantchemotherapy for gastric cancer with S-1, an oral fluoropyrimidine[J]．N Engl J Med，2007，357(18): 1810-1820.

7分			3种风险
积分	LNM风险(%)	风险类别	LNM风险(%)	无额外治疗的5年CSS(%)
0	1.6	低	2.5	99.6
1	2.6	?	?	?
2	4.9	中	6.7	96.0
3	7.4	?	?	?
4	8.3	?	?	?
5	19.9	高	22.7	90.1
6	27.3	?	?	?
7	26.7	?	?	?

7分			3种风险
积分	LNM风险(%)	风险类别	LNM风险(%)	无额外治疗的5年CSS(%)
0	1.6	低	2.5	99.6
1	2.6	?	?	?
2	4.9	中	6.7	96.0
3	7.4	?	?	?
4	8.3	?	?	?
5	19.9	高	22.7	90.1
6	27.3	?	?	?
7	26.7	?	?	?

	eCura系统	指南
出版日期	2017/3	2018/1
概念	预测LNM风险评分系统	治愈性标准
对象	ER术后未达治愈标准(指南eCura C-2)	EGC的ER患者
分类	3(7分)	4
类别	低风险(2.5%LNM风险)	eCura A(可忽略的LNM风险)
?	中风险(6.7%LNM风险)	eCura B(可忽略的LNM风险)
?	高风险(22.7%LNM风险)	eCura C-1(极低的LNM风险)
?	?	eCura C-2(明确的LNM风险)→建议通过eCura系统评估LNM风险

	eCura系统	指南
出版日期	2017/3	2018/1
概念	预测LNM风险评分系统	治愈性标准
对象	ER术后未达治愈标准(指南eCura C-2)	EGC的ER患者
分类	3(7分)	4
类别	低风险(2.5%LNM风险)	eCura A(可忽略的LNM风险)
?	中风险(6.7%LNM风险)	eCura B(可忽略的LNM风险)
?	高风险(22.7%LNM风险)	eCura C-1(极低的LNM风险)
?	?	eCura C-2(明确的LNM风险)→建议通过eCura系统评估LNM风险

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