Clinicopathological study of lymph-node metastasis in 1,389 patients with early gastric cancer: assessment of indications for endoscopic resection.
BACKGROUND
The endoscopic resection of early gastric cancers (EGC) is a standard technique in Japan and is increasingly used throughout the world. Further experience in the treatment of EGC and a clearer delineation of the factors related to lymph-node metastasis would permit a more accurate assessment of endoscopic resection.


METHODS
The study group comprised 1,389 patients with EGC who underwent gastrectomy with lymph-node dissection. We evaluated the relations of lymph-node metastasis to clinicopathological factors.


RESULTS
Of the 718 patients with intramucosal carcinomas, 14 (1.9%) had lymph-node metastasis. All cases of lymph-node metastasis were associated with ulceration. No lymph-node metastasis was found in patients with intramucosal carcinomas without ulceration, irrespective of tumor size and histological type. Lymph-node metastasis was present in 14 (4.7%) of the 296 patients who had cancer with a submucosal invasion depth of less than 500 microm (sm1). Significantly increased rates of lymph-node metastasis were associated with undifferentiated types, ulcerated lesions and lymphatic invasion. No lymph-node metastasis was found in patients with differentiated sm1 carcinomas 30 mm or less in diameter without ulceration. Lymph-node metastasis occurred in 29% of the patients who had cancer with a submucosal invasion depth of 500 microm or more (sm2).


CONCLUSIONS
This large series of patients with EGC provides further evidence supporting the expansion of indications for endoscopic treatment, as well as warns against potential risks.
Haruta
Hidenori
H
Clinical Institute of Digestive Disease Surgical Branch, Jichi Medical University, Tochigi, Japan. haruta511@yahoo.co.jp
Hosoya
Yoshinori
Y
Sakuma
Kazuya
K
Shibusawa
Hiroyuki
H
Satoh
Kiichi
K
Yamamoto
Hironori
H
Tanaka
Akira
A
Niki
Toshiro
T
Sugano
Kentaro
K
Yasuda
Yoshikazu
Y
D000328:Adult; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*