Abstract
Background: Less invasive treatment is the current trend in many surgical fields. Most patients
with early gastric cancer do not have lymph node metastasis. Thus extensive resection
of the stomach and extended lymph node dissection do not appear to be necessary. Methods: In a retrospective study, 890 consecutive patients with early gastric cancer who
had undergone standard gastrectomy were assessed for depth of invasion, gross appearance,
and maximum diameter of the tumor to examine the possibility of limiting the extent
of lymph node dissection. A variety of limited gastrectomies have been developed and
now include endoscopic mucosal resection, wedge resection, segmental gastrectomy,
limited proximal gastrectomy, and distal hemigastrectomy. Results: A retrospective study revealed that extensive lymph node dissection did not improve
the survival of patients with early gastric cancer. Endoscopic mucosal resection was
suitable for cancers of the depressed type of less than 1 cm in diameter and the elevated
type of less than 2 cm in diameter. Wedge, segmental, or limited proximal gastrectomy
was suitable for the elevated type of 2 to 3 cm in diameter. The elevated type of
more than 3 cm in diameter and the depressed type of 1 to 3 cm in diameter sometimes
involved metastasis to group 1 nodes. The depressed type of more than 3 cm in diameter
sometimes involved metastasis to group 2 nodes. Thus such cases should be treated
by gastrectomy with dissection of potentially metastatic lymph nodes. Conclusions: Limitation of the extent of gastrectomy and lymph node dissection may be possible,
depending on the gross appearance and size of the tumor. (Surgery 1999;125:148-54.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The general rule of JRSGC and treatment results by the rule.Cancer Lett. 1989; 45: 155
- R2 compared with R1 resection for gastric cancer: morbidity and mortality in a prospective, randomized trial.Eur J Surg. 1992; 158: 413-418
- Surgical approach to early gastric cancer with lymph node metastasis.World J Surg. 1989; 13: 630-636
- Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma.Br J Surg. 1988; 75: 110-112
- R2/3 gastrectomy for gastric carcinoma: an audited experience of a consecutive series.Br J Surg. 1985; 72: 146-148
- Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial.Lancet. 1996; 347: 995-999
- Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients.Lancet. 1995; 345: 745-748
- Limited operation for gastric cancer in the elderly.Br J Surg. 1996; 83: 836-839
- Japanese classification of gastric carcinoma: first English edition.Kanehara & Co, Ltd, Tokyo1995
- Significance of strip biopsy, with particular references to endoscopic “mucosectomy.”.Dig Endosc. 1989; 1: 4-9
- Simple and reliable technique for local resection of early gastric cancer.Br J Surg. 1996; 83: 413-414
- Recurrence in early gastric cancer.Surgery. 1990; 107: 489-495
- Recurrence of early gastric cancer: follow-up of 1475 patients and review of the Japanese literature.Cancer. 1993; 72: 3174-3178
- Is extensive lymphadenectomy necessary for surgical treatment of intramucosal carcinoma of the stomach?.Arch Surg. 1989; 124: 309-311
- New trends in surgery for gastric cancer in Japan.J Surg Oncol. 1994; 56: 221-226
- Non-radical therapy for early gastric cancer.Br J Surg. 1994; 81: 551-553
- Predictors of lymph node metastasis in early gastric cancer.Br J Surg. 1992; 79: 245-247
- Lymphadenectomy for cure in patients with early gastric cancer and lymph node metastasis.Am J Surg. 1988; 155: 476-480
- Clinicopathological features of mucosal carcinoma of the stomach with lymph node metastasis in eleven patients.Br J Surg. 1986; 73: 431-433
- Lymph node metastasis from early gastric cancer: endoscopic resection of tumour.Br J Surg. 1992; 79: 241-244
- Nutritional evaluation of limited gastrectomy for early gastric cancer.in: 1st International Gastric Cancer Congress. Monduzzi Ediore S p A, Bologna (Italy)1995: 619-623
Article info
Publication history
Accepted:
August 27,
1998
Footnotes
☆Reprint requests: Shunichi Tsujitani, MD, PhD, Tottori University, Faculty of Medicine, Department of Surgery I, 36-1 Nishi-cho, Yonago 683, Japan.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
