The Benefits of Endoscopic Resection
- For patients with early-stage gastric cancer, a minimally-invasive procedure known as endoscopic resection can provide an alternative to traditional surgery.
- The procedure involves using a flexible tube with a camera to remove cancerous tissue from the stomach lining.
- The technique is typically recommended for patients with early-stage gastric cancer, where the tumor is confined to the mucosal or submucosal layers of the stomach (the most inner layers of the stomach).
- Studies have shown that patients who undergo endoscopic resection have excellent long-term outcomes, with five-year survival rates comparable to those of surgical patients.
A gastric cancer diagnosis can be overwhelming, but advances in medical technology, such as endoscopic resection (ER), have made treatment options less invasive and more effective.
Read MoreWhat is Endoscopic Resection?
“A surgeon or gastroenterologist goes in with a camera into the stomach and visualizes the tumor. He is able to ressect the tumor without cutting into the abdomen or going from the outside in,” Dr. Hornstein explains. “Basically, this is an inside out surgery where the tumor is removed with minimal damage to peripheral tissues. However, this can only be offered to patients that have very early stage disease.”Endoscopic resection involves using a flexible tube with a camera to remove cancerous tissue from the stomach lining. This technique is typically recommended for patients with early-stage gastric cancer, where the tumor is confined to the mucosal or submucosal layers of the stomach (the most superficial layers of the stomach.) There are two main types of endoscopic resection commonly used in treating gastric cancer:
- Endoscopic Mucosal Resection (EMR): Best suited for small, non-invasive tumors, EMR involves lifting the tumor with a saline injection and then removing it using a snare.
- Endoscopic Submucosal Dissection (ESD): This advanced technique is often used for larger or more complex tumors. ESD involves using an electrosurgical knife to dissect the tumor from deeper layers of the stomach. This method is preferred when en bloc resection (removing the tumor in one piece) is necessary for larger tumors.
Who is Eligible for Endoscopic Resection?
Endoscopic resection is typically reserved for patients with early-stage gastric cancer who meet certain criteria. According to the Japanese Gastric Cancer Association, absolute indications for endoscopic resection include:
- Tumors confined to the mucosal layer (T1 stage)
- Well-differentiated adenocarcinomas
- Tumors smaller than 2 cm with no ulceration
Expanded criteria allow for endoscopic resection in larger tumors or those with minimal invasion into the submucosal layer. However, these cases carry a slightly higher risk and may require more complex procedures, such as ESD.
The Benefits of Endoscopic Resection
For many patients with EGC, endoscopic resection offers several advantages over traditional surgical methods:
- Minimally Invasive: Endoscopic resection does not require large incisions, leading to less pain, shorter hospital stays, and faster recovery times.
- Preservation of the Stomach: This procedure allows the patient to keep their stomach intact, unlike gastrectomy, which removes part or all of the stomach. This preservation significantly improves post-treatment quality of life.
- Lower Risk of Complications: Compared to surgery, endoscopic resection has a lower risk of complications such as infections or post-operative bleeding.
Studies have shown that patients who undergo endoscopic resection have excellent long-term outcomes, with five-year survival rates comparable to those of surgical patients. Moreover, studies from regions such as Korea and Japan, where endoscopic resection is widely used, report survival rates exceeding 90% for early-stage patients. Patients without high risk features in their resected tumor may not require additional therapy. It is important to note that these patients were carefully selected, if a endoscopic resection is not offered, it may be because your cancer is too extensive to adequately treat for EMR alone
What to Expect During & After Resection
Endoscopic resection is generally performed under sedation, and patients typically experience minimal discomfort. The procedure can last from 60 minutes to a few hours, depending on the tumor size and complexity. After the resection, patients may experience mild throat soreness or abdominal discomfort, but these symptoms usually subside within a few days.
Recovery after endoscopic resection is relatively quick compared to traditional surgery. According to experts from New York University, most people are able to go home as soon as the sedation wears off. Although a longer stay may be required for complex cases involving ESD.
Long-Term Outlook and Surveillance
The success of endoscopic resection relies not only on the initial procedure but also on diligent post-treatment surveillance. Recurrence is rare, but follow-up care is critical to detect any new lesions or metachronous gastric cancers (a new cancer developing in the stomach). Regular gastroscopies and imaging, such as computed tomography (CT) scans, are typically recommended every 6 to 12 months.
For patients who undergo successful endoscopic resection, the five-year survival rate is promising. In studies, complete resection rates using ESD reached up to 96%, with a recurrence-free survival rate of 100% in some patient groups. These outcomes demonstrate that, for the right candidates, endoscopic resection is a highly effective treatment.
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