title: Advanced gastric cancer with early cancer macroscopic appearance: is it worthy of D2 lymphadenectomy?
abstract: BACKGROUND
  Previous studies report that 5.9-22.2% of patients with preoperatively diagnosed early gastric cancers were eventually proven to have advanced gastric cancers by postoperative pathological examination. Such misdiagnosed cases commonly had cancers with macroscopic appearance like early gastric cancer and consequently can be recognized as a subgroup of cancer, namely advanced gastric cancer with early cancer macroscopic appearance (eAGC). Theoretically eAGCs might require D2 lymphadenectomy, but frequently undergo limited lymphadenectomy. However, the validity of the limited surgery is still unclear.
  
  
  METHODS
  Clinicopathologic features of 134 patients with eAGC were retrospectively reviewed and compared with those of patients with early gastric cancers and advanced gastric cancers, respectively.
  
  
  RESULTS
  Clinicopathologic features of eAGCs were similar to those of submucosa cancers, but significantly different from those of mucosa cancers and other muscularis propria cancers. Tumor size, lymphatic and/or blood vessels invasion (LBVI), and depth of invasion were identified as independent factors predicting lymph node metastasis; however, postoperative stage was not. All patients with eAGCs were proven to have lymph node metastasis restricted to the perigastric lymph nodes and lymph nodes at stations 7, 8a, and 9. Age, LBVI, and depth of invasion were independent prognostic factors for patients with preoperatively diagnosed early gastric cancers; however, the misdiagnosis of early cancer and the option of lymphadenectomy (D2 or not D2) had no impact on patient survival. The incidence of recurrence of eAGCs was similar to that of submucosa cancers, but significantly different from that of mucosa cancers and other muscularis propria cancers.
  
  
  CONCLUSIONS
  Modified gastrectomy B (dissection of perigastric lymph nodes and nodes at stations 7, 8a, and 9) might be recommended for patients with eAGCs.
authors.affiliation: Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Sun
authors.forename: Zhen-ning
authors.initials: ZN
authors.lastname: Wang
authors.forename: Guo-lian
authors.initials: GL
authors.lastname: Zhu
authors.forename: Bao-jun
authors.initials: BJ
authors.lastname: Huang
authors.forename: Kai
authors.initials: K
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
authors.forename: De-ming
authors.initials: DM
authors.lastname: Li
authors.forename: Hui-mian
authors.initials: HM
authors.lastname: Xu
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000368:Aged; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome