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The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection: is the minimal lymph node dissection applicable?

A retrospective study

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Abstract

Purpose

The purpose of this study was to identify risk factors associated with lymph node (LN) metastasis in early gastric cancer patients who underwent endoscopic resection (ER) and to evaluate the feasibility of minimal LN dissection in these patients.

Methods

From January 2001 to March 2011, patients who underwent gastrectomy with lymphadenectomy due to the potential risk of LN metastasis after ER were enrolled at National Cancer Center, Korea. The incidence, risk factors, and distribution of LN metastasis were evaluated.

Results

Of the 147 enrolled patients, the LN metastasis was identified in 12 patients (8.2 %). The incidence of LN metastasis was not significantly increased in patients with submucosal invasion, lymphovascular invasion, and mixed undifferentiated histology [odds ratio (OR), 5.55, 1.349, and 0.387; 95 % confidence interval (CI), 0.688–43.943, 0.405–4.494, and 0.081–1.84, respectively]. Tumor size more than 2 cm was significantly associated with LN metastasis (OR, 14.056; 95 % CI, 1.76–112.267). The incidence of LN metastasis gradually increased from 3.2 to 20 %, as number of risk factors increased (P = 0.019). LN metastasis was present primarily along the perigastric area in all except two patients (1.4 %) with skip metastasis to extragastric area.

Conclusions

Standard surgery with at least D1 + LN dissection must be recommended for patients who proved to have risk factors for LN metastasis after ER, because the potential of skip metastasis is not negligible. Nevertheless, the minimal LN dissection, such as sentinel basin dissection, might be applied cautiously in patients with small-sized tumors after ER.

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Acknowledgment

This work was supported by grant (NCC 1110550-2) from the National Cancer Center, Republic of Korea.

Disclosures

Drs. Sang Yong Son, Ji Yeon Park, Keun Won Ryu, Bang Wool Eom, Hong Man Yoon, Soo Jeong Cho, Jong Yeul Lee, Chan Gyoo Kim, Jun Ho Lee, Myeong-Cherl Kook, Il Ju Choi, and Young-Woo Kim have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea

    Sang Yong Son

  2. Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, 111 Jeongbalsanro, Ilsandong-Gu, Goyang-si, Gyeonggi-do, 410-769, South Korea

    Ji Yeon Park, Keun Won Ryu, Bang Wool Eom, Hong Man Yoon, Soo Jeong Cho, Jong Yeul Lee, Chan Gyoo Kim, Jun Ho Lee, Myeong-Cherl Kook, Il Ju Choi & Young-Woo Kim

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  1. Sang Yong Son
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  2. Ji Yeon Park
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  3. Keun Won Ryu
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  4. Bang Wool Eom
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  5. Hong Man Yoon
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  6. Soo Jeong Cho
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  7. Jong Yeul Lee
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  8. Chan Gyoo Kim
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  9. Jun Ho Lee
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  10. Myeong-Cherl Kook
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  11. Il Ju Choi
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  12. Young-Woo Kim
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Corresponding author

Correspondence to Keun Won Ryu.

Additional information

Sang Yong Son and Ji Yeon Park contributed equally to this study.

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Son, S.Y., Park, J.Y., Ryu, K.W. et al. The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection: is the minimal lymph node dissection applicable?. Surg Endosc 27, 3247–3253 (2013). https://doi.org/10.1007/s00464-013-2901-z

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  • DOI: https://doi.org/10.1007/s00464-013-2901-z

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