title: Risk of limited lymph node dissection in patients with clinically early gastric cancer: indications of extended lymph node dissection for early gastric cancer.
abstract: BACKGROUND
  Laparoscopic gastrectomy is usually indicated in T1 N0-1 early gastric cancer (EGC). Limited lymph node dissection, such as D1+, is applied in these cases. However, preoperative staging is not always correct, and the risk of undertreatment thus exists.
  
  
  METHODS
  Patients with clinically early gastric cancer (cEGC) who underwent gastrectomy with lymph node dissection of D2 and over were selected from 4,021 patients with gastric cancer. The station numbers of all metastatic lymph nodes (MLNs) were identified, and MLNs were classified into groups 1 and 2 (including lymph nodes of second tier and over) on the basis of the system of the Japanese Gastric Cancer Association, irrespective of the number of MLNs. Clinicopathological data were compared according to the existence of lymph node metastasis and the classification of MLNs.
  
  
  RESULTS
  Of 1,308 patients with cEGC who fulfilled the inclusion criteria, 1,184 (90.5 %) were diagnosed pathologically with EGC. Among 126 patients with cEGC who were diagnosed with lymph node metastasis, 93 patients had only group 1 MLNs and 33 patients had group 2 MLNs. Tumor location in the proximal third of the stomach (odds ratio 5.450) and ulceration (odds ratio 11.928) were significant factors for group 2 metastasis.
  
  
  CONCLUSIONS
  Extended lymph node dissection is recommended in cEGC with ulceration or disease located in the proximal third of the stomach.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
authors.forename: Han Hong
authors.initials: HH
authors.lastname: Lee
authors.forename: Han Mo
authors.initials: HM
authors.lastname: Yoo
authors.forename: Kyo Young
authors.initials: KY
authors.lastname: Song
authors.forename: Hae Myung
authors.initials: HM
authors.lastname: Jeon
authors.forename: Cho Hyun
authors.initials: CH
authors.lastname: Park
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*