Advancements in Early Gastric Cancer Management: A Focus on Minimally Invasive Techniques

Early gastric cancer (EGC) is a significant, global health concern. However,screening programs have improved early detection and outcomes; particularly in East Asia. The management of EGC has evolved from radical gastrectomy with lymph node dissection to minimally invasive approaches that preserve gastric function, while ensuring oncological safety. Endoscopic techniques; such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), offer effective treatment for select patients, with low risk of lymph node metastasis. These approaches provide comparable survival rates to surgery, while reducing postoperative complications, hospitalization and recovery time. Lymph node metastasis remains a key prognostic factor in EGC management. While radical surgery is necessary for cases with lymphatic spread, function-preserving surgeries; including pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG), aim to maintain gastric function and improve quality of life. The sentinel lymph node concept has further refined surgical strategies by minimizing unnecessary lymphadenectomy. Risk stratification tools; such as the eCura scoring system, assist in predicting lymph node involvement and guiding individualized treatment decisions. Patients classified as low-risk may benefit from endoscopic resection alone, while those at higher risk may require additional surgical intervention. The growing role of laparoscopic approaches has further advanced minimally invasive treatment, demonstrating comparable oncologic outcomes to open surgery. As treatment paradigms continue to shift, a multidisciplinary approach integrating endoscopic, surgical, and risk-based strategies is essential for optimizing patient outcomes. Future research will further refine treatment guidelines, ensuring a balance between oncological safety and functional preservation in EGC management.