Published online Feb 21, 2022. doi: 10.3748/wjg.v28.i7.693
Peer-review started: October 26, 2021
First decision: December 27, 2021
Revised: January 4, 2022
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: February 21, 2022
Early gastric cancer (EGC) is an invasive carcinoma involving only the stomach mucosa or submucosa, independently of lymph node status. EGC represents over 50% of cases in Japan and in South Korea, whereas it accounts only for approximately 20% of all newly diagnosed gastric cancers in Western countries. The main classification systems of EGC are the Vienna histopathologic classification and the Paris endoscopic classification of polypoid and non-polypoid lesions. A careful endoscopic assessment is fundamental to establish the best treatment of EGC. Generally, EGCs are curable if the lesion is completely removed by endoscopic resection or surgery. Some types of EGC can be resected endoscopically; for others the most appropriate treatment is surgical resection and D2 lymphadenectomy, especially in Western countries. The favorable oncological prognosis, the extended lymphadenectomy and the reconstruction of the intestinal continuity that excludes the duodenum make the prophylactic cholecystectomy mandatory to avoid the onset of biliary complications.
Core Tip: Early gastric cancer (EGC) is an invasive stomach cancer confined to the mucosal or submucosal lining and represents approximately 20% of gastric cancers in Western countries. A correct classification allows the most appropriate treatment. Some types of EGC are adequately treated by endoscopic mucosal resection, whilst others need gastrectomy. In Western countries, due to a higher incidence of the diffuse histotype and the less widespread advanced endoscopic procedures, surgical resection and D2 lymphadenectomy are regarded as the “gold standard” treatment.