Current Status and Challenges of Local Resection for Early Gastric Cancer in East Asia

Background/Objectives: Standard gastrectomy with lymph node dissection up to D1+ achieves good oncologic control for early gastric cancer not amenable to endoscopic submucosal dissection, yet it frequently leads to post-gastrectomy syndromes and long-term nutritional impairment. Local resection of the stomach reduces post-gastrectomy syndrome; however, the extent of lymph node dissection should be limited beyond D1+ in such cases. This review evaluates the safety of local resection for early gastric cancer reported in East Asia. Methods: We reviewed current concepts and clinical evidence regarding (i) the limitations of preoperative nodal staging, (ii) sentinel node biopsy and function-preserving gastrectomy, and (iii) functional outcomes and procedure-specific complications following local resection, with a focus on delayed gastric emptying. Results: Conventional imaging and biomarkers are inadequate for reliable preoperative identification of node-negative disease. Conversely, sentinel node biopsies demonstrate high intraoperative diagnostic accuracy. Large prospective studies have revealed that, when indications are strictly adhered to, sentinel node biopsy-guided function-preserving gastrectomy can yield survival outcomes comparable to those of standard gastrectomy. The indications for local resection include solitary submucosal tumors below 4 cm in size, diagnosed as node-negative by sentinel node biopsy. Although the available quality-of-life data are generally favorable, there is risk of delayed gastric emptying in local resection with limited lymph node dissection in cases of early gastric cancer. Postoperative gastric deformity following closure was identified as the primary cause. Conclusions: Local resection for submucosal gastric cancer guided by sentinel node biopsy may be oncologically acceptable and function-preserving; however, the prevention of gastric deformity is crucial for its safe implementation.