Abstract
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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Article info
Publication history
Accepted:
January 14,
2001
Footnotes
*Supported in part by a grant-in-aid (No.12877194 and No.11671254) for Scientific Research from the Ministry of Education, Japan.
**Reprint requests: Michio Ogawa, Department of Surgery II, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
★Surgery 2001;129:714-9
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
