Treatment of early gastric cancer.

Early or superficial gastric cancer identifies a lesion that is confined to the mucosa or submucosa layer and that even in the presence of lymph nodes metastasis can be successfully treated with resection and lymph node dissection. In presence of cancer that invades the submucosa the incidence of N2 metastasis raises to 3-5%, and even though a D2 procedure is indicated as the postoperative mortality is similar to D1 procedure. Early gastric cancer of the mid portion of the stomach can be treated with a distal D2 pylorus preserving gastrectomy that has the advantage to reduce the incidence of dumping syndrome; this result can be achieved with a complete dissection of the infrapyloric nodes preservng part of the suprapyloric nodes to spare the right gastric artery. Endoscopic mucosal resection is another therapeutic option available in presence of a mucosal gastric cancer less than 2 cm, well differentiated without ulceration; among 50 cases treated so far, 32 cases were completed resected and they are free of disease up to now. The main risks of this procedure are hemorrhage (5%) and perforation (6.4%).