title: Is lymphadenectomy needed for all submucosal gastric cancers?
abstract: OBJECTIVE
  To find out if it is feasible to extend the indication for local resection of submucosal gastric cancer without increasing the risk of lymph node metastases.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital, Japan.
  
  
  METHODS
  104 patients with gastric cancer confined to the submucosal layer who underwent conventional gastrectomy with lymphadenectomy.
  
  
  METHODS
  The risk of nodal metastases was analysed retrospectively depending on the depth of submucosal invasion, size of the tumour, and other clinicopathological findings.
  
  
  METHODS
  The degree of submucosal invasion, size of the tumour, and incidence of lymph node metastasis.
  
  
  RESULTS
  15/104 patients (14%) had lymph node metastases. No patient in whom submucosal invasion was less than 500 microm or tumour was less than 15 mm in diameter developed lymph node metastases. Fewer patients had lymphatic permeation (37/89) and venous involvement (21/89) in the group without lymph node metastases.
  
  
  CONCLUSIONS
  These data seem to support the hypothesis that early, minimally invasive, gastric cancer measuring < 15 mm in diameter could be treated by endoscopic mucosal or local resection, and gastrectomy with lymphadenectomy might be unnecessary.
authors.affiliation: Second Department of Surgery, Tokyo Medical and Dental University, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamada
authors.forename: Z
authors.initials: Z
authors.lastname: Nihei
authors.forename: T
authors.initials: T
authors.lastname: Yamashita
authors.forename: Y
authors.initials: Y
authors.lastname: Shirota
authors.forename: W
authors.initials: W
authors.lastname: Ichikawa
authors.forename: K
authors.initials: K
authors.lastname: Sugihara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*