Quantifying early gastric cancer in Australia: What is the opportunity for gastric endoscopic submucosal dissection?

Background and aims Endoscopic submucosal dissection (ESD) is the recommended treatment for early gastric cancer (EGC). However, there are challenges in attaining expertise in ESD in countries where the incidence of gastric cancer, and proportion diagnosed at an early stage of disease is relatively low. This study aims to establish the proportion of gastric cancer meeting histological criteria for EGC which may be suitable for ESD, in a Western population. Methods Gastric cancers reported to the Victorian Cancer Registry between January 2011 and December 2016 were analysed. EGC was defined as tumour confined to mucosa (T1a) or submucosa (T1b). Histology reports were analysed using Japanese and European guidelines to identify potential ESD candidates. Criteria for extended ESD were based on grade of differentiation, tumour depth, lymphovascular and perineural invasion and ulceration. Results Twenty percent of 1217 gastric cancers was EGC (237 cases), with detailed histopathology reports suitable for evaluating ESD criteria recorded in 182 cases. Standard and extended ESD criteria were met in 46% (84/182) and 75% (132/182), respectively. Actual treatment of the 237 EGC was endoscopic in 14% (n=33) and surgery in 86% (n=204). Endoscopically treated EGCs were more likely to be stage T1a and located in the proximal stomach. Conclusions EGCs represented 20% of reported gastric adenocarcinomas with the majority fulfilling criteria for ESD. ESD should be considered in the management algorithm and discussed at tumour board meetings involving interventional endoscopists. To increase utilisation of ESD, systems need to be implemented to improve training, accreditation, and access to ESD.