Clinicopathological features of the superficial spreading type of early gastric cancer

Abstract

Abstract:Background. During a 10-year period (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995), 59 of 538 patients with early gastric cancer (11.0%) had the superficial spreading type of gastric cancer. We attempted to elucidate the clinicopathological features and investigated the influence of those features on surgical procedures and patient prognoses. Methods. These 59 superficial spreading lesions were analyzed with respect to macroscopic type, lymph node (LN) metastasis, recurrent pattern, and method of surgical operation. In addition, the lesions were compared with those of 393 other patients with small-sized cancer. Results. In both groups, the IIc type macroscopic lesion occurred most frequently, and the depressed subtype occurred more frequently than the elevated subtype. There was no significant histologic difference between the groups. The incidence of LN metastasis was 8.7% in early gastric cancer, 7.1% in small-sized cancer, and 20.3% in superficial spreading cancer. The incidence of lymphovascular invasion was 24.4% in small-sized cancer and 50.8% in superficial spreading cancer. The incidences of LN metastasis and lymphovascular invasion were greater in superficial spreading cancer than in smallsized cancer. Despite extensive preoperative examination, determination of the tumor margin was impossible in 26 of the 59 patients with superficial spreading cancer. The incidence of recurrence was 2.0% in small-sized cancer and 5.1% in superficial spreading cancer. Conclusions. A wide resection with extensive lymph node dissection (D2 or more) seems to be an appropriate treatment for the superficial spreading type of early gastric cancer.

Current approaches to the diagnosis and treatment of early gastric cancer

“…Для поверхностно-распространенно-го рака характерна высокая частота продолженного роста и реци-дивов после лечения и худший прогноз по сравнению с другими типами РРЖ. Большинство исследователей считают адекватным объемом операции для данной формы РРЖ гастрэктомию с ЛАЭ D2 [33].…”

Early gastric carcinoma: spread and multicentricity

“…Endoscopically, despite extensive preoperative examination, determination of the tumor margin is impossible in half of the cases [15]. Japanese authors have suggested the performance of contrast endoscopy, using dye-spraying techniques, and endoscopic clipping of the gastric mucosa by biopsies at intervals of 1 cm [15].…”

“…Japanese authors have suggested the performance of contrast endoscopy, using dye-spraying techniques, and endoscopic clipping of the gastric mucosa by biopsies at intervals of 1 cm [15]. However, the extent of resection is usually decided on clinical grounds by the surgeon at operation.…”

“…In the present series, of the 64 patients who underwent a subtotal gastrectomy, the first resection line was invaded in 4. Kasakura et al [15] have suggested that all patients must undergo total gastrectomy. However, the low rate of resection-line involvement suggests that subtotal gastrectomies should be performed under certain conditions, rather than total gastrectomies.…”

“…However, after subtotal gastrectomy, about 20% of deaths are caused by recurrent lesions limited to the gastric remnant [1,8,9,12,14]. Therefore, total gastrectomy has been proposed in all patients suspected of having EGC [7,15]. To the contrary, there are trends toward endoscopic resections, and a major effort is being made to identify patients suitable for a limited resection [16].…”