Surgical options for early gastric cancer

The recurrence rate of surgical treatment for early gastric cancer is 2.7% to 9110%, among which residual cancer at the resection margin is one of the reasons for failure, especially the unclear boundary between type IIb and IIc early gastric cancer and normal mucosa, which can easily cause errors in naked eye judgment and lead to residual cancer at the resection margin.

Mo Yi once divided the infiltration patterns of type IIb and IIc early gastric cancer into four types: full-thickness, surface, middle-thickness and submucosal. The surface of the infiltrating edge of the middle-thickness and submucosal cancer nests is often covered with normal mucosa, which can easily cause an illusion in naked eye observation during surgery. Secondly, the surface-enlarged early gastric cancer with a larger lesion range often spans two partitions of the stomach. Because patients often have the idea that "the resection range of early gastric cancer can be appropriately conservative", it is easy to cause cancer residues at the resection margin. In addition, multiple gastric cancers in early gastric cancer are more common than those in advanced gastric cancer, with an incidence of 1.5% to 18.4%, especially multiple cancers in the cardia of the gastric body, which often lead to cancer residues at the resection margin.

Since no lesions can be seen on the gastric serosal surface during laparotomy for early gastric cancer, and since the lesions are small or superficial, the surgeon often cannot feel the location and range of the lesions. Therefore, it is necessary to apply pigments by gastroscopy or inject pigments into the gastric wall to mark them before surgery, so that the surgeon can use them as a basis for determining the resection line. Generally, the resection margin for differentiated cancer is required to be at least 3 cm away from the lesion, and 5 cm for undifferentiated cancer. If multiple cancers are suspected, frozen sections should be examined to ensure that there is no cancer residue at the resection margin.