Title : Redefining local treatment boundaries in early gastric cancer: Multicenter evidence supporting endoscopic full-thickness resection from the NEGCC
Abstract:
Background: Endoscopic full-thickness resection (EFTR) has emerged as an advanced minimally invasive technique capable of achieving en bloc resection of gastric wall lesions while preserving organ integrity. However, its role in early gastric cancer (EGC), particularly in patients with high-risk features for submucosal invasion or lymph node metastasis, remains insufficiently defined. This multicenter study from the National Early Gastrointestinal Cancer Cohort (NEGCC) aimed to evaluate the feasibility, safety, and short-term oncologic outcomes of EFTR in EGC.
Methods: We conducted a retrospective multicenter analysis of patients aged 18–80 years with histologically confirmed EGC (Tis or T1N0M0) who underwent EFTR between January 2016 and January 2025. Eligible patients presented with at least one high-risk feature, including lesion size ≥2 cm, ulceration, submucosal invasion, or poorly differentiated histology. EFTR was performed either as a purely endoscopic super minimally invasive stepwise full-thickness resection (sft-SMIR) or as laparoscopy-assisted EFTR combined with regional lymphadenectomy. Primary outcomes were technical success and R0 resection. Secondary outcomes included adverse events, lymph node status, and short-term recurrence.
Results: Twenty-one patients with 22 EGC lesions from four tertiary centers were included. All lesions were successfully resected en bloc, achieving a 100% R0 resection rate. Thirteen patients (61.9%) underwent sft-SMIR, while eight (38.1%) received laparoscopy-assisted EFTR with lymphadenectomy. One patient (12.5%) in the lymphadenectomy group was found to have a single metastatic lymph node. No severe intraoperative complications occurred. Postoperative adverse events were infrequent and manageable, including gastroparesis, localized peritonitis, and one anastomotic leak. During a median follow-up of 14 months, no tumor recurrence, distant metastasis, or mortality was observed.
Conclusions: EFTR demonstrates excellent technical success and favorable short-term oncologic outcomes in selected patients with early gastric cancer, including those with high-risk pathological features. By combining precise local resection with selective lymph node assessment, EFTR may expand organ-preserving treatment strategies and reduce overtreatment. Prospective studies with longer follow-up are warranted to confirm its long-term oncologic safety.
