From the Guidelines
The treatment algorithm for Stage 1A gastric cancer primarily involves endoscopic resection for early gastric cancers that meet specific criteria, and surgical gastrectomy with lymph node dissection for those that do not, as recommended by the most recent guidelines 1. The criteria for endoscopic resection include:
- Confined to mucosa
- Well-differentiated G1-2
- Less than 2 cm in diameter
- Non-ulcerated For lesions that do not meet these criteria, surgical gastrectomy with lymph node dissection is the standard approach, which typically involves:
- Distal subtotal gastrectomy for distal tumors
- Total gastrectomy for proximal tumors
- D1+ or D2 lymphadenectomy depending on the specific characteristics of the tumor Minimally invasive approaches such as laparoscopic or robotic-assisted gastrectomy can be considered for suitable candidates, as suggested by recent guidelines 1. Adjuvant chemotherapy is generally not recommended for Stage 1A gastric cancer, as the prognosis after complete resection is excellent, with 5-year survival rates exceeding 90% 1. Post-treatment surveillance should include:
- Regular endoscopic examinations every 6-12 months for the first 1-2 years, then annually
- Periodic imaging studies and laboratory tests to monitor for recurrence Nutritional support and management of post-gastrectomy symptoms are important aspects of follow-up care to ensure optimal quality of life after treatment, as emphasized by recent studies 1. Some key points to consider in the treatment algorithm include:
- The importance of lymph node dissection, with a D1+ or D2 lymphadenectomy recommended depending on the tumor characteristics 1
- The potential use of perioperative chemotherapy, with a triplet regimen including a fluoropyrimidine, a platinum compound, and docetaxel recommended for 2-3 months pre- and post-operatively 1
- The consideration of adjuvant radiotherapy or chemotherapy for patients with an R1 resection, although this is not standard practice 1
From the Research
Treatment Algorithm for Stage 1A Gastric Cancer
The treatment algorithm for Stage 1A gastric cancer involves several approaches, including:
- Surgical resection, which is the cornerstone of treatment for gastric cancer, often combined with perioperative chemotherapy 2
- Lymph node dissection, which is a crucial component of the surgical treatment of gastric cancer, with D1 lymphadenectomy currently recommended for early stage tumors 2
- Endoscopic resection (ER) of mucosal T1 gastric cancer, which is a widely accepted treatment option if a definitive R0 resection can be achieved, according to the German guidelines on resection criteria 3
- Laparoscopic gastric cancer (LAG) resection with adequate lymphadenectomy, which has shown significant benefits in short-term postoperative outcome compared to open gastrectomy (OG) in the treatment of early stage gastric cancer 3
Surgical Management
The surgical management of Stage 1A gastric cancer involves:
- Total or subtotal gastrectomy, depending on the location of the tumor and the ability to gain adequate tumor-free margins 4, 5
- D2 lymphadenectomy, which can be performed safely and facilitates the resection of the minimum 15 lymph nodes required for adequate staging 5
- Adjacent organ resection, which should be used only in highly selected patients with R0 resection as the goal 5
Adjuvant Therapy
Adjuvant therapy, including chemotherapy and radiotherapy, has been demonstrated to have a beneficial role in survival for patients with gastric cancer 4