John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Endoscopic resection for early cancer of digestive tract: mucosectomy or sub mucosal dissection? Volume 17, issue 4, juillet-août 2010

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Unité d'endoscopie digestive et de l'unité d'exploration médico-chrirugicale oncologique Institut Paoli-Calmettes, 232 Bd St-Marguerite 13273 Marseille cedex 9

Early gastrointestinal cancers are defined as lesions limited to the mucosa or submucosa without invading the muscularis propria, regardless of the presence of lymph node metastases. Since 10 years, endoscopic resection has become an alternative to surgery. Surgical resection of early GI cancers offers an excellent (90-100%) chance of cure based on several series. Any major surgical intervention, however, carries risks of complications including wound infection, prolonged hospital stay, anesthetic complication and death. This is especially problematic in elderly patients or in patients with concomitant severe organ dysfunction including heart failure, kidney failure, and lung disease. For this reason, endoscopic therapy may provide an attractive and less invasive treatment option that may ultimately prove to be safer in this selected subgroup of patients, and may be able to translate to the general population. These techniques include endoscopic mucosal resection and endoscopic submucosal dissection which are now accepted as treatments for early gastrointestinal cancers in selected cases.