This protocol applies to a well-defined subset of early gastric cancer characterised by poorly differentiated tubular or poorly cohesive histology — including signet-ring cell type — where the lesion is confined to the mucosa, measures ≤2 cm on endoscopic estimation, and has no ulceration within the tumor.
Endoscopic resection may be cautiously considered — following sufficient clinical discussion — when all three endoscopic criteria are met: estimated tumor size ≤2 cm, disease limited to the mucosal layer, and no ulcer present within the tumor. The specific histologic subtype (poorly differentiated tubular or poorly cohesive, including signet-ring cell) makes careful post-resection pathologic review essential.
When pathologic assessment of the resected specimen reveals risk factors for lymph node involvement, a surgical intervention targeting the stomach and regional lymph nodes is indicated. The complete protocol — including eligibility criteria, procedural decision points, and escalation thresholds — is available in full below.
DOI: 10.5230/jgc.2025.25.e11
Endoscopic resection could be cautiously considered for poorly differentiated tubular or poorly cohesive (including signet-ring cell) EGCs meeting the following endoscopic findings after sufficient discussion: endoscopically estimated tumor size ≤2 cm, endoscopically mucosal cancer, and no ulcer in the tumor.
However, when risk factors for LN metastasis (tumor size >2 cm, submucosal invasion, ulcer in the tumor, and lymphovascular invasion) are revealed in pathologic reports, additional gastrectomy may be necessary.
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