title: Submucosal gastric cancer with lymph node metastasis.
abstract: OBJECTIVE
  The intraoperative assessment of lymph node metastasis of gastric cancer remains difficult and the characteristics of recurrence after gastrectomy are not well known regarding submucosal cancer.
  
  
  METHODS
  We examined 452 patients with submucosal gastric cancer and compared the clinicopathologic features as well as recurrence patterns between the 71 cases with lymph node metastasis (group I) and the 381 without it (group II).
  
  
  RESULTS
  The mean tumor sizes were 44.8 and 33.5 mm, respectively (P < 0.01). The incidences of lymphatic invasion and vascular invasion were 91.5% (65/71) and 45.1% (32/71) in group I, which were significantly higher than those in group II (36.7 and 14.2%, 140/381 and 54/381, respectively, P < 0.01). A total of 21 patients (4.6%, 21/452) experienced recurrence after undergoing a gastrectomy and hematogenic recurrence was the most frequent type of recurrence (2.0%, 9/452). However, in group I, lymphatic recurrence was most frequently observed (7.0%, 5/71), and it was more frequent than in group II (0.3%, 1/381, P < 0.01). The median intervals between gastrectomy and recurrence were 34.5 and 64.0 months in groups I and II, respectively (P < 0.05).
  
  
  CONCLUSIONS
  The submucosal cancer with larger size, lymphatic invasion, and vascular invasion has high risks for lymph node metastasis. Furthermore, a strict follow-up for lymphatic as well as hematogenic recurrence is important for the patients with node positive submucosal cancer, especially within 5 years after operation.
authors.affiliation: Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Morita
authors.forename: H
authors.initials: H
authors.lastname: Baba
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
authors.forename: A
authors.initials: A
authors.lastname: Taketomi
authors.forename: S
authors.initials: S
authors.lastname: Kohnoe
authors.forename: Y
authors.initials: Y
authors.lastname: Seo
authors.forename: T
authors.initials: T
authors.lastname: Saito
authors.forename: H
authors.initials: H
authors.lastname: Tomoda
authors.forename: K
authors.initials: K
authors.lastname: Sugimachi
mesh_terms: D005260:Female; D005743:Gastrectomy; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007564:Japan / Q000453:epidemiology; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009360:Neoplastic Cells, Circulating; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery