Original Communications| Volume 129, ISSUE 6, P714-719, June 2001

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Characterization of early gastric cancer and proposal of the optimal therapeutic strategy


      Background and Aims. The optimal protocol of the treatment for early gastric cancer has not been fully established. The current study was designed to elucidate the relationship between the depth of tumors with or without an ulcer and the presence of lymph node metastasis and to establish the optimal and practical therapeutic strategy for patients with early gastric cancer. Patients and Methods. A retrospective analysis of 1051 patients with early gastric cancer treated by gastrectomy with D1 or D2 lymph node dissection was performed. The patients were divided into those with mucosal (M) tumors and those with submucosal (SM) tumors. These 2 groups were subclassified, depending on the coexistence of ulcer or the degree of submucosal invasion, and were characterized in relation to clinicopathologic factors and 5-year prognosis. Results. The incidence of lymph node metastases from SM tumors (19.8%, 85 of 430) was more frequent than that from M tumors (2.3%, 14 of 621) (P <.001). All M tumors with lymph node involvement, including tumors smaller than 1.5 cm in diameter, had ulceration or ulceration scar in the lesions. SM tumors that had invaded less than 200 μm in depth (SM1a) had significantly less lymph node involvement than those with deeper invasion. The node metastases were confined to epigastric lymph nodes (N1) in both M tumors with ulceration or ulceration scar and SM1a tumors. Conclusions. All macroscopic M tumors without ulceration or ulceration scar should be considered for endoscopic mucosal resection. The need for reoperation for a formal gastrectomy with lymphadenectomy or a limited surgical operation will vary depending on the pathologic analysis of endoscopic mucosal resection specimens (depth of invasion, presence of ulceration).(Surgery 2001;129:714-9.)
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        • Tada M
        • Murakami A
        • Karita M
        • Yanai H
        • Okita K.
        Endoscopic resection of early gastric cancer.
        Endoscopy. 1993; 25: 445-450
        • Sano T
        • Kobori O
        • Muto T.
        Lymph node metastasis from early gastric cancer: endoscopic resection of tumor.
        Br J Surg. 1992; 79: 241-244
        • Honmyo U
        • Misumi A
        • Murakami A
        • Mizumoto S
        • Yoshinaka I
        • Maeda M
        • et al.
        A clinicopathological study on surgically resected stomachs in patients with preceding endoscopic mucosal resection for early gastric cancer.
        Dig Endosc. 1996; 8: 192-198
        • Ohgami M
        • Kumai K
        • Otani Y
        • Wakabayashi G
        • Kubota T
        • Kitajima M.
        Laparoscopic wedge resection of the stomach for early gastric cancer using a lesion-lifting method.
        Dig Surg. 1994; 11: 64-67
        • Goh P
        • Kum C.
        Laparoscopic Billroth II gastrectomy. A review.
        Surg Oncol. 1993; 2: 13-18
        • Nagai Y
        • Tanimura H
        • Takifuji K
        • Kashiwagi H
        • Yamato H
        • Nakatani Y.
        Laparoscope-assisted Billroth I gastrectomy.
        Surg Laparosc Endosc. 1995; 5: 281-287
        • Korenaga D
        • Haraguchi M
        • Tsujitani D
        • Okamura T
        • Tamada R
        • Sugimachi K.
        Clinicopathological features of mucosal carcinoma of the stomach with lymph node metastasis in eleven patients.
        Br J Surg. 1986; 73: 431-433
        • Habu H
        • Takeshita K
        • Sunagawa M
        • Endo M.
        Lymph node metastasis in early gastric cancer.
        Int Surg. 1986; 71: 244-247
        • Sowa M
        • Kato Y
        • Nishimura M
        • Kudo T
        • Maekawa H
        • Umegawa K.
        Surgical approach to early gastric cancer with lymph node metastasis.
        World J Surg. 1989; 13: 630-636
        • Lawrence M
        • Shiu MH
        Early gastric cancer.
        Ann Surg. 1991; 213: 327-334
        • Kwon SJ
        • Kim GS
        Prognostic significance of lymph node metastasis in advanced carcinoma of the stomach.
        Br J Surg. 1996; 83: 1600-1603
        • Kurihara N
        • Kubota T
        • Otani Y
        • Ohgami M
        • Kumai K
        • Sugiura H
        • et al.
        Lymph node metastasis of early gastric cancer with submucosal invasion.
        Br J Surg. 1998; 85: 835-839
        • Nakamura K
        • Morisaki T
        • Sugitani A
        • Ogawa T
        • Uchiyama A
        • Kinukawa N
        • et al.
        An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis.
        Cancer. 1999; 85: 1500-1505
        • Hochwald SN
        • Brennan MF
        • Klimstra DS
        • Kim S
        • Karpeh MS
        Is lymphadenectomy necessary for early gastric cancer?.
        Ann Surg Oncol. 1999; 6: 664-670
        • Tio TL
        • Coene PPLO
        • Schouwink MH
        • Tytgat GNJ.
        Esophagogastric carcinoma. Preoperative TNM classification with endosonography.
        Radiology. 1989; 173: 411-417
        • Yasuda K
        • Mukai H
        • Cho E
        • Nakajima M
        • Uno K
        • Tanaka S
        • et al.
        Evaluation of the degree of gastric cancer invasion by endoscopic ultrasonography (EUS) for endoscopic treatment of early disease.
        Stomach and Intestine. 1992; 27: 1167-1174
        • Kida M
        • Tanabe S
        • Watanabe M
        • Kokutou M
        • Kondou I
        • Yamada Y
        • et al.
        Staging of gastric cancer with endoscopic ultrasonography and endoscopic mucosal resection.
        Endoscopy. 1998; 30: 64-68
        • Japanese Classification of Gastric Carcinoma
        Japanese Research Society for Gastric Cancer.
        1st English edition. Kanehara & Co, LTD, Tokyo1999
        • Sano T
        • Okuyama Y
        • Kobori O
        • Shimizu T
        • Morioka Y.
        Early gastric cancer. Endoscopic diagnosis of depth of invasion.
        Dig Dis Sci. 1990; 35: 1340-1344
        • Fenoglio CM
        • Kaye GI
        • Lane N.
        Distribution of human colonic lymphatics in normal, hyperplastic, and adenoma tissue.
        Gastroenterology. 1973; 64: 51-66
        • Lehnert T
        • Erlandson RA
        • Decosse JJ
        Lymph and blood capillaries of the human gastric mucosa: a morphologic basis for metastasis in early gastric carcinoma.
        Gastroenterology. 1985; 89: 939-950
        • Listrom MB
        • Fenoglio-Preiser CM
        Lymphatic distribution of the stomach in normal, inflammatory, hyperplastic, and neoplastic tissue.
        Gastroenterology. 1987; 93: 506-514
        • Bonenkamp JJ
        • Songun I
        • Sasako M
        • Welvaart K
        • Plukkar JT
        • Obertop H
        • et al.
        Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients.
        Lancet. 1995; 345: 745-748
        • Degiuli M
        • Sasako M
        • Ponzetto A
        • Allone T
        • Soldati T
        • Calgaro M
        • et al.
        Extended lymph node dissection for gastric cancer: results of a prospective, multi-centre analysis of morbidity and mortality in 118 consecutive cases.
        Eur J Surg Oncol. 1997; 23: 310-314
        • Maruyama K.
        The most important prognostic factors for gastric cancer patients. A study using univariate and multivariate analysis.
        Scand J Gastroenterol. 1987; 22: 63-68
        • Ohgaki M
        • Takahashi T
        • Hagiwara A
        • Yamasaki J
        • Togawa T.
        Effect of extensive lymph node dissection on the survival of early gastric cancer.
        Hepatogastroenterology. 1999; 46: 2096-2099
        • Bozzetti F
        • Bonfanti G
        • Morabito A
        • Bufalino R
        • Menotti V
        • Andreola S
        • et al.
        A multifactorial approach for the prognosis of patients with carcinoma of the stomach after curative resection.
        Surg Gynecol Obstet. 1986; 162: 229-234
        • Wu CW
        • Hsieh MC
        • Lo SS
        • Tsay SH
        • Lui WY
        • P'eng FK
        Relation of number of positive lymph nodes to the prognosis of patients with primary gastric adenocarcinoma.
        Gut. 1996; 38: 525-527
        • Harrison LE
        • Karpeh MS
        • Brennan MF
        Extended lymphadenectomy is associated with a survival benefit for node-negative gastric cancer.
        J Gastrointest Surg. 1998; 2: 126-131
        • Meyer HJ
        • Jahne J.
        Lymph node dissection for gastric cancer.
        Semin Surg Oncol. 1999; 17: 117-124
        • Roukos DH
        Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer.
        Ann Surg Oncol. 1999; 6: 46-56