Clinicopathological study of lymph-node metastasis in 1389 patients with early gastric cancer: Assessment of indications for endoscopic resection

• Published in: Journal of digestive diseases 2008-11, Vol.9 (4), p.213-218
• Main Authors: HARUTA, Hidenori, HOSOYA, Yoshinori, SAKUMA, Kazuya, SHIBUSAWA, Hiroyuki, SATOH, Kiichi, YAMAMOTO, Hironori, TANAKA, Akira, NIKI, Toshiro, SUGANO, Kentaro, YASUDA, Yoshikazu
• Format: Article
• Language: English
• Subjects: early gastric cancer; endoscopic mucosal resection; endoscopic submucosal dissection; gastrectomy; lymph-node metastasis
• ISSN: 1751-2972; 1751-2980
• DOI: 10.1111/j.1751-2980.2008.00349.x

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 1389 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 μm (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 μm or more (sm2). CONCLUSION:  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.