title: Increased risk of lymph node metastasis in mucosal gastric cancer with extra indication for endoscopic mucosal resection.
abstract: BACKGROUND
  Selected cases of clinical mucosal gastric cancer can be treated endoscopically. But mucosal gastric cancer, which has a higher incidence of lymph node metastasis, should be treated by gastrectomy with lymph node dissection. Laparoscopy-assisted gastrectomy is usually indicated for the surgical treatment of mucosal gastric cancer.
  
  
  METHODS
  From April 2005 to December 2007, 148 consecutive patients with clinical mucosal gastric cancer who underwent laparoscopy-assisted gastrectomy were investigated to clarify the clinicopathologic findings in this patient group.
  
  
  RESULTS
  Of the patients who underwent gastrectomy, 93 (63%) had tumors>20 mm in diameter and 92 (62%) had undifferentiated cancer. The frequency of lymph node metastasis was 8% (12 patients). One patient had second-compartment lymph node metastasis (station 8a). In patients with lymph node metastasis, 11 (92%) had an ulcer scar and 11 (92%) had undifferentiated tumors. None of the patients met the criteria for extended endoscopic submucosal dissection.
  
  
  CONCLUSIONS
  The incidence of lymph node metastasis in patients with mucosal gastric cancer in whom gastrectomy is indicated is higher than reported previously. More careful consideration is needed for the possibility of lymph node metastasis in this era of endoscopic submucosal dissection.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Tetsu
authors.initials: T
authors.lastname: Fukunaga
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Yorimasa
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Akira
authors.initials: A
authors.lastname: Miki
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ogawa
authors.forename: Jun
authors.initials: J
authors.lastname: Higashijima
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Ohyama
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000368:Aged; D016145:Endoscopy, Digestive System; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*