An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis

Abstract

BACKGROUND Newly developed therapies for early gastric carcinoma attempt to consider patients' quality of life, but the applicability and effectiveness of these treatments remain undetermined. METHODS Clinicopathologic data of 612 consecutive patients with early gastric carcinoma, all of whom were treated by D1 and D2 gastrectomy, were analyzed. Patients with and without lymph node metastases were compared in relation to age and gender distributions, surgical procedures, histopathology of the tumors, 5‐year prognosis, and in reference to the preoperative and intraoperative assessments. RESULTS The overall incidence of lymph node metastases was 5.7%. Tumor depth and size were related to lymph node metastases judged by univariate and multivariate analyses. Patients with mucosal tumors showed no relation between metastatic rate and tumor size, whereas those with submucosal tumors showed an increasing metastatic rate with tumor size. In all cases but one, lymph node metastases were confined to lymph node stations defined as Group 1 locations. Preoperative endoscopic ultrasonography showed a 55% diagnostic accuracy in determining tumor depth and a 15% sensitivity in diagnosing lymph node metastases. CONCLUSIONS Patients with early gastric carcinoma may be candidates for endoscopic mucosal resection if their tumor is confined to the mucosa and measures < 1 cm in greatest dimension. Other limited resections including D1 gastrectomy or standard D2 gastrectomy based on tumor depth and size are appropriate. Based on the current study findings, the authors propose a useful algorithm for managing such patients. Cancer 1999;85:1500–5. © 1999 American Cancer Society.

Number of lymph node metastases and its prognostic significance in early gastric cancer: A multicenter italian study

“…It has been already demonstrated that the risk is related to the number of metastatic nodes [9]. The incidence of nodal metastases ranges from 1% to 3% for tumors confined to the mucosa and from 11% to 20% for those invading the submucosa [10][11][12]; the number of metastatic lymph nodes showed to be an important prognostic factor.…”

Effect of obesity on laparoscopy‐assisted distal gastrectomy compared with open distal gastrectomy for gastric cancer

“…Recent data have shown that gastric cancer is both the fourth most common cancer and the second most common cause of cancer death worldwide [22], and it is one of the most common malignancies in Japan [23]. Favorable surgical results are attributed to early diagnosis and standardization of surgical procedures [24][25][26][27][28][29][30].…”

Minimally invasive treatment for gastric cancer: Approaches and selection process

“…By using these data, it has been suggested that minimally invasive treatment for EGC can be safely applied to selected patients without compromising the adequacy of oncologic resection, the recurrence rates, or the long-term survival. The suggested risk factors for lymph node metastasis with EGC are submucosal invasion, larger tumor size, undifferentiated histology, the presence of ulcer, and the presence or absence of lymphatic or blood vessel invasion [22][23][24][25][26]. Although not all of the studies have confirmed the same risk factors for lymph node metastasis, the above mentioned factors should be considered for use in selection of patients for minimally invasive surgery.…”

“…These EMR indications are based on the analysis of databases containing several hundreds or even thousands of patients with EGC who have undergone gastric resection with lymphadenectomy to identify the specific features of EGC that are without lymph node metastasis [11,29]. As mentioned in the prior section, the risk of lymph node metastasis increases rapidly for submucosally invasive cancers [22][23][24][25][26]30]. In general, EMR is not considered indicated for undifferentiated (poorly differentiated adenocarcinoma and/or signet-ring cell carcinoma) type, even for small lesions, because of a significant risk of lymph-node involvement.…”