Prelim inary study of super minimally invasive stepwise full-thickness resection for the treatment of gastric cancer

doi:10.3877/cma.j.issn.2095-7157.2025.01.004

Abstract

Abstract:

Objective

To expand the therapeutic indications of super minimally invasive surgery（SMIS） for gastric cancer （GC），this study proposed a novel technique termed super minimally invasive stepwise full-thickness resection （sft-SMIR） and evaluated its safety and efficacy in treating early gastric cancer （EGC）.

Methods

Eight EGC patients admitted to the First Medical Center of Chinese PLA General Hospital from August 2023 to September 2024 underwent sft-SMIR.Inclusion criteria included lesion diameter ＜3 cm，no lymph node or distant metastasis，and EGC staging （Tis，T1a，or T1b）.The procedure involved dual marking，stepwise non-full-thickness and full-thickness resection，and defect closure with clips.Postoperative outcomes were assessed using the SMIS-EGC therapeutic efficacy evaluation system，with follow-up for complications and recurrence.

Results

All patients achieved successful en bloc resection（100% rate）.Postoperative evaluation showed 7 cases as SMIS-Cure A （cure） and 1 case as SMIS-Cure B2 （clinical cure）.During a mean follow-up of 8.6 months （range： 4-16 months），no complications or recurrence occurred.One patient with SM3 submucosal infiltration received adjuvant chemotherapy，while others required no additional treatment.

Conclusion

The sft-SMIR technique enables curative en bloc resection of EGC，demonstrating preliminary safety and efficacy.Further multicenter studies with larger cohorts are warranted to validate long-term outcomes.

Key words: Gastric cancer, Super minimally invasive surgery, Stepwise full-thickness resection, Cure evaluation system, Expand indications

Qianqian Chen, Huikai Li, Yaoqian Yuan, Bo Ning, Kunming Lv, Qun Shao, Enqiang Linghu. Prelim inary study of super minimally invasive stepwise full-thickness resection for the treatment of gastric cancer[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(01): 15-18.

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Figures/Tables 2

References 10

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病例	年龄/性别	病变部位	样本大小		内镜下所见		病理诊断			T 分期	SMISCure分级	随访时间（月）
病例	年龄/性别	病变部位	样本面积（cm）	全层切除面积（cm）	有溃疡	肿瘤大小（cm）	组织类型	分化程度	浸润深度	T 分期	SMISCure分级	随访时间（月）
1	67/ 女	胃窦前壁	5. 2×5. 2	1. 8×1. 2	有	3. 0×2. 0	腺癌	中分化	黏膜肌层	T1a	A	6
2	49/ 男	胃底	2. 5×1. 5	0. 4×0. 3	无	0. 4×0. 3	腺癌	高分化	黏膜下层（SM1）	T1b	A	6
3	59/ 男	胃角	6. 5×4. 0	1. 5×0. 5	有	0. 5×0. 3	腺癌	低分化	黏膜层	Tis	A	7
4	39/ 男	胃窦大弯	4. 3×4. 0	0. 6×0. 5	无	0. 6×0. 5	印戒细	未分化	黏膜层	Tis	A	15
5	70/ 男	胃角	4. 0×3. 3	1. 5×0. 5	无	1. 8×1. 5	胞癌腺癌	高分化	黏膜下层（SM1）	T1b	A	7
6	53/ 男	胃体大弯	5. 8×4. 2	1. 5×1. 0	有	1. 7×1. 2	腺癌	中分化	黏膜下层（SM3）	T1b	B3	16
7	71/ 女	胃窦大弯	4. 0×3. 5	1. 0×0. 8	有	1. 2×1. 1	腺癌	中分化	黏膜肌层	T1a	A	7
8	53/ 男	胃体后壁	5. 8×4. 5	2. 2×1. 0	有	2. 5×1. 8	腺癌	高分化	黏膜肌层	T1a	A	5

病例	年龄/性别	病变部位	样本大小		内镜下所见		病理诊断			T 分期	SMISCure分级	随访时间（月）
病例	年龄/性别	病变部位	样本面积（cm）	全层切除面积（cm）	有溃疡	肿瘤大小（cm）	组织类型	分化程度	浸润深度	T 分期	SMISCure分级	随访时间（月）
1	67/ 女	胃窦前壁	5. 2×5. 2	1. 8×1. 2	有	3. 0×2. 0	腺癌	中分化	黏膜肌层	T1a	A	6
2	49/ 男	胃底	2. 5×1. 5	0. 4×0. 3	无	0. 4×0. 3	腺癌	高分化	黏膜下层（SM1）	T1b	A	6
3	59/ 男	胃角	6. 5×4. 0	1. 5×0. 5	有	0. 5×0. 3	腺癌	低分化	黏膜层	Tis	A	7
4	39/ 男	胃窦大弯	4. 3×4. 0	0. 6×0. 5	无	0. 6×0. 5	印戒细	未分化	黏膜层	Tis	A	15
5	70/ 男	胃角	4. 0×3. 3	1. 5×0. 5	无	1. 8×1. 5	胞癌腺癌	高分化	黏膜下层（SM1）	T1b	A	7
6	53/ 男	胃体大弯	5. 8×4. 2	1. 5×1. 0	有	1. 7×1. 2	腺癌	中分化	黏膜下层（SM3）	T1b	B3	16
7	71/ 女	胃窦大弯	4. 0×3. 5	1. 0×0. 8	有	1. 2×1. 1	腺癌	中分化	黏膜肌层	T1a	A	7
8	53/ 男	胃体后壁	5. 8×4. 5	2. 2×1. 0	有	2. 5×1. 8	腺癌	高分化	黏膜肌层	T1a	A	5

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