Diagnosis and treatment strategies of early gastric cancer

With the widespread implementation of endoscopic screening, advances in endo-scopic diagnostic technologies, and updates in clinical management concepts, the detection rate of early gastric cancer (EGC) has steadily increased. The treatment goal has gradually shifted from merely achieving oncologic cure to balancing tumor eradication with organ preservation, functional main-tenance, and quality of life. Precision management of EGC relies on high‑quality preoperative evaluation, incorporating tumor location, size, histology, invasion depth, and lymph node metastasis risk to guide the choice among endoscopic therapy, function‑preserving surgery, or standard radical gastrectomy. In terms of diagnostic progress, novel endoscopic techniques, including next-generation image-enhanced endoscopy, magnifying endoscopy, confocal laser endomicroscopy, and artificial intelligence-assisted systems, allow precise lesion localization, characterization, and margin assess-ment, signifi-cantly improving early lesion detection and diagnostic consistency. Preoperative assessment should also prospectively identify patients at risk for non‑curative endoscopic resection, providing guidance for subsequent surgical planning. Regarding therapeutic advances, endoscopic submucosal dissection enables en bloc resection and comprehensive pathological evaluation, yet its indications remain constrained by histologic curability and low lymph node metastasis risk; patients with non‑curative resection require risk‑stratified additional surgery. Surgical management is evolving from standard radical gastrectomy to function‑preserving and precision approaches, including pylorus-preserving gastrectomy, proximal gastrectomy, sentinel lymph node navigation, and laparoscopy-endoscopy cooperative procedures, integrating oncologic control with functional preservation. Although sentinel lymph node navigation can optimize nodal clearance, its accuracy is limited by skip and micro-metastatic spread. Overall, EGC management emphasizes the synergistic integration of endoscopic and surgical approaches, preoperative risk stratification, and multidisci-plinary coordination. The paradigm is moving beyond simply answering "can it be resected? "toward achieving" precise resection, functional preservation, and improved long‑term outcomes".